Provider Demographics
NPI:1407970098
Name:SIESS CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:SIESS CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:G
Authorized Official - Last Name:SIESS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-776-4855
Mailing Address - Street 1:101 SMITH DR
Mailing Address - Street 2:SUITE7
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-4129
Mailing Address - Country:US
Mailing Address - Phone:724-776-4855
Mailing Address - Fax:724-776-1560
Practice Address - Street 1:101 SMITH DR
Practice Address - Street 2:SUITE7
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-4129
Practice Address - Country:US
Practice Address - Phone:724-776-4855
Practice Address - Fax:724-776-1560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003052L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA11026526OtherCAQH
PA1022426OtherGATEWAY
PA414047OtherHEALTH AMERICA
PA100472OtherUPMC
PA1060255Medicare UPIN
PA11026526OtherCAQH