Provider Demographics
NPI:1477580025
Name:SIRUCEK, ANTHONY JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JAMES
Last Name:SIRUCEK
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 1:263 2ND AVE N
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6117
Mailing Address - Country:US
Mailing Address - Phone:208-733-5555
Mailing Address - Fax:208-733-0687
Practice Address - Street 1:263 2ND AVE N
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6117
Practice Address - Country:US
Practice Address - Phone:208-733-5555
Practice Address - Fax:208-733-0687
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDC-436111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID00010018812OtherBLUE SHIELD OF IDAHO
IDC4363OtherBLUE CROSS
IDC4363OtherBLUE CROSS