Provider Demographics
NPI:1952632846
Name:SISK, JONATHAN D (DC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:D
Last Name:SISK
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 1:202 S SHELBY ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29702-1542
Mailing Address - Country:US
Mailing Address - Phone:864-839-2081
Mailing Address - Fax:864-839-2081
Practice Address - Street 1:202 S SHELBY ST
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:SC
Practice Address - Zip Code:29702-1542
Practice Address - Country:US
Practice Address - Phone:864-839-2081
Practice Address - Fax:866-203-1019
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-17
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3533111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1629391230OtherGROUP NPI FOR DR. JONATHAN SISK