Provider Demographics
NPI:1710105820
Name:SIRISKY, KIMBERLY SHEA (DC)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:SHEA
Last Name:SIRISKY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:SIRISKY
Other - Last Name:CIANCIOLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1001 PHYSICIANS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5746
Mailing Address - Country:US
Mailing Address - Phone:843-571-1020
Mailing Address - Fax:843-573-0788
Practice Address - Street 1:1001 PHYSICIANS DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5746
Practice Address - Country:US
Practice Address - Phone:843-571-1020
Practice Address - Fax:843-573-0788
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3585111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor