Provider Demographics
NPI:1801971528
Name:SIGAFOOSE, CHRISS J (DC,PA)
Entity type:Individual
Prefix:
First Name:CHRISS
Middle Name:J
Last Name:SIGAFOOSE
Suffix:
Gender:M
Credentials:DC,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1694 TAMIAMI TRL S
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-1633
Mailing Address - Country:US
Mailing Address - Phone:941-493-2688
Mailing Address - Fax:941-493-2783
Practice Address - Street 1:1694 TAMIAMI TRL S
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-1633
Practice Address - Country:US
Practice Address - Phone:941-493-2688
Practice Address - Fax:941-493-2783
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3232111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL97807OtherBCBC GROUP
PADC001945LOtherLIC. NO.
GACHIR001454OtherLIC.NO.
FL97807OtherBCBC GROUP
FLK4569Medicare ID - Type UnspecifiedGROUP
FLT55960Medicare UPIN