Provider Demographics
NPI:1063843431
Name:SIFTON, CHARLES (LAC)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:SIFTON
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-1904
Mailing Address - Country:US
Mailing Address - Phone:207-841-0949
Mailing Address - Fax:
Practice Address - Street 1:6 CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-1904
Practice Address - Country:US
Practice Address - Phone:207-841-0949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC380171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist