Provider Demographics
NPI:1083735955
Name:SIRACUSA, JOHN (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SIRACUSA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 N MILITARY TRL
Mailing Address - Street 2:SUITE #7
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6059
Mailing Address - Country:US
Mailing Address - Phone:561-309-9133
Mailing Address - Fax:
Practice Address - Street 1:1225 N. MILITARY TRAIL
Practice Address - Street 2:SUITE 7
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-4717
Practice Address - Country:US
Practice Address - Phone:561-309-9133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0007161111N00000X
FLPS42127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No183500000XPharmacy Service ProvidersPharmacist