Provider Demographics
NPI:1841302783
Name:BISESI, RAYMOND C (D C)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:C
Last Name:BISESI
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 W SILVER SPRING DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-4217
Mailing Address - Country:US
Mailing Address - Phone:414-461-9250
Mailing Address - Fax:414-461-3553
Practice Address - Street 1:2501 W SILVER SPRING DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209-4217
Practice Address - Country:US
Practice Address - Phone:414-461-9250
Practice Address - Fax:414-461-3553
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2088111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor