Provider Demographics
NPI:1023301579
Name:SISOLAK, JAMES TODD (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:TODD
Last Name:SISOLAK
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 1:128 STATE ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-6629
Mailing Address - Country:US
Mailing Address - Phone:978-465-1500
Mailing Address - Fax:978-465-7501
Practice Address - Street 1:128 STATE ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-6629
Practice Address - Country:US
Practice Address - Phone:978-465-1500
Practice Address - Fax:978-465-7501
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2426111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor