Provider Demographics
NPI:1861457749
Name:SIESS, CLIFTON G (DC)
Entity Type:Individual
Prefix:DR
First Name:CLIFTON
Middle Name:G
Last Name:SIESS
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 1:101 SMITH DR
Mailing Address - Street 2:SUITE7
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-4129
Mailing Address - Country:US
Mailing Address - Phone:724-776-4855
Mailing Address - Fax:724-776-1560
Practice Address - Street 1:101 SMITH DR
Practice Address - Street 2:
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-4129
Practice Address - Country:US
Practice Address - Phone:724-776-4855
Practice Address - Fax:724-776-1560
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003052L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100472OtherUPMC
PA414047OtherHEALTH AMERICA
PA11026526OtherCAQH
PA001392600OtherHIGHMARK BLUE SHIELD
PA1022426OtherGATEWAY
PA100472OtherUPMC