Provider Demographics
NPI:1609878636
Name:SIFFORD, ALAN KENT (DC)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:KENT
Last Name:SIFFORD
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 1:1720 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-5906
Mailing Address - Country:US
Mailing Address - Phone:574-534-6824
Mailing Address - Fax:574-534-1957
Practice Address - Street 1:1720 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-5906
Practice Address - Country:US
Practice Address - Phone:574-534-6824
Practice Address - Fax:574-534-1957
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001188A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100114410Medicaid
IN228620Medicare ID - Type Unspecified
IN100114410Medicaid