Provider Demographics
NPI:1437493434
Name:SIRAGUSA, JOSEPH S (DC, M ED)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:S
Last Name:SIRAGUSA
Suffix:
Gender:M
Credentials:DC, M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 OVERLOOK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-3929
Mailing Address - Country:US
Mailing Address - Phone:704-497-2606
Mailing Address - Fax:
Practice Address - Street 1:1000 OVERLOOK RIDGE RD
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-3929
Practice Address - Country:US
Practice Address - Phone:704-497-2606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1401111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic