Provider Demographics
NPI:1770521882
Name:SISCOE, RONALD GLEN (DC)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:GLEN
Last Name:SISCOE
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 1:1825 LIMEKILN PIKE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:DRESHER
Mailing Address - State:PA
Mailing Address - Zip Code:19025-1739
Mailing Address - Country:US
Mailing Address - Phone:215-646-6400
Mailing Address - Fax:
Practice Address - Street 1:1825 LIMEKILN PIKE
Practice Address - Street 2:SUITE 5
Practice Address - City:DRESHER
Practice Address - State:PA
Practice Address - Zip Code:19025-1739
Practice Address - Country:US
Practice Address - Phone:215-646-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007499L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
032279Medicare ID - Type Unspecified
U77386Medicare UPIN