Provider Demographics
NPI:1043620420
Name:SIFFORD CLINIC OF CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:SIFFORD CLINIC OF CHIROPRACTIC, INC.
Other - Org Name:SIFFORD CLINIC OF CHIROPRACTIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:SIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:574-534-6824
Mailing Address - Street 1:1720 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-5906
Mailing Address - Country:US
Mailing Address - Phone:574-534-6824
Mailing Address - Fax:574-534-1957
Practice Address - Street 1:1720 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-5906
Practice Address - Country:US
Practice Address - Phone:574-534-6824
Practice Address - Fax:574-534-1957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001188111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty