Provider Demographics
NPI:1730131558
Name:STISO, FRANK R (DC)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:R
Last Name:STISO
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 1:2401 HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1101
Mailing Address - Country:US
Mailing Address - Phone:732-528-7746
Mailing Address - Fax:
Practice Address - Street 1:2401 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1101
Practice Address - Country:US
Practice Address - Phone:732-528-7746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC05592111N00000X
NJMC005592101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
116912Medicare PIN