Provider Demographics
NPI:1821172636
Name:SISAK, MATTHEW DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DAVID
Last Name:SISAK
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 1:5091 ROUTE 119 HWY S
Mailing Address - Street 2:
Mailing Address - City:HOMER CITY
Mailing Address - State:PA
Mailing Address - Zip Code:15748-7226
Mailing Address - Country:US
Mailing Address - Phone:724-479-8606
Mailing Address - Fax:
Practice Address - Street 1:5091 ROUTE 119 HWY S
Practice Address - Street 2:
Practice Address - City:HOMER CITY
Practice Address - State:PA
Practice Address - Zip Code:15748-7226
Practice Address - Country:US
Practice Address - Phone:724-479-8606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA081097U3UMedicare ID - Type Unspecified