Provider Demographics
NPI:1427541093
Name:SIDOTI, EVANN T (DC)
Entity Type:Individual
Prefix:DR
First Name:EVANN
Middle Name:T
Last Name:SIDOTI
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 1:180 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-6205
Mailing Address - Country:US
Mailing Address - Phone:973-773-2244
Mailing Address - Fax:
Practice Address - Street 1:180 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-6205
Practice Address - Country:US
Practice Address - Phone:973-773-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00753000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor