Provider Demographics
NPI:1295183812
Name:SIOUTIS, SOULTANA SUSIE (DC, CPED)
Entity type:Individual
Prefix:DR
First Name:SOULTANA
Middle Name:SUSIE
Last Name:SIOUTIS
Suffix:
Gender:F
Credentials:DC, CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 NELSON STREET
Mailing Address - Street 2:
Mailing Address - City:SARNIA
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N7T5H9
Mailing Address - Country:CA
Mailing Address - Phone:519-383-1304
Mailing Address - Fax:519-383-0984
Practice Address - Street 1:251 NELSON STREET
Practice Address - Street 2:
Practice Address - City:SARNIA
Practice Address - State:ONTARIO
Practice Address - Zip Code:N7T5H9
Practice Address - Country:CA
Practice Address - Phone:519-383-1304
Practice Address - Fax:519-383-0984
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ3355111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor