Provider Demographics
NPI:1801901483
Name:SITO, RAYMOND W (DC)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:W
Last Name:SITO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:RAY
Other - Middle Name:W
Other - Last Name:SITO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1904 EASTWOOD RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-5721
Mailing Address - Country:US
Mailing Address - Phone:910-256-2655
Mailing Address - Fax:910-256-2358
Practice Address - Street 1:1904 EASTWOOD RD
Practice Address - Street 2:SUITE 103
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-5721
Practice Address - Country:US
Practice Address - Phone:910-256-2655
Practice Address - Fax:910-256-2358
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2345111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908861Medicaid
NC08861OtherBCBS
NC8908861Medicaid