Provider Demographics
NPI:1083946560
Name:RON SISCOE, PC
Entity Type:Organization
Organization Name:RON SISCOE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:SISCOE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-876-6180
Mailing Address - Street 1:3215 EDGMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:19015-3104
Mailing Address - Country:US
Mailing Address - Phone:610-876-6180
Mailing Address - Fax:
Practice Address - Street 1:3215 EDGMONT AVE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:PA
Practice Address - Zip Code:19015-3104
Practice Address - Country:US
Practice Address - Phone:610-876-6180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007499L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty