Provider Demographics
NPI:1942308994
Name:SIEFFERT, JAMES R (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:SIEFFERT
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 1:4540 E BASELINE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4613
Mailing Address - Country:US
Mailing Address - Phone:480-272-8944
Mailing Address - Fax:480-237-5682
Practice Address - Street 1:4540 E BASELINE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4613
Practice Address - Country:US
Practice Address - Phone:480-272-8944
Practice Address - Fax:480-237-5682
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5294111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U53718Medicare UPIN
68986Medicare ID - Type Unspecified
AZZ129280Medicare PIN