Provider Demographics
NPI:1477045961
Name:SISU CHIRO PLLC
Entity Type:Organization
Organization Name:SISU CHIRO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:CARMEN
Authorized Official - Last Name:MEAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-887-0555
Mailing Address - Street 1:222 AUBURN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-6005
Mailing Address - Country:US
Mailing Address - Phone:207-887-0555
Mailing Address - Fax:207-699-3831
Practice Address - Street 1:222 AUBURN ST STE 102
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103
Practice Address - Country:US
Practice Address - Phone:207-887-0555
Practice Address - Fax:207-699-3831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-31
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty