Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 27-2971 | OR |
NPI | 1710036744 |
---|---|
Provider Name | Dr. Dana William Sibilla |
First Address | Portland, OR 97232-1502 |
Second Address | Portland, OR 97232-1502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U70851 | (02) | OR |