Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 1539 | NC |
N | 111NS0005X | Chiropractic Sports Physician | 17334 | CA |
NPI | 1164449195 |
---|---|
Provider Name | Dr. William Eliason Sisson JR. |
First Address | Wilmington, NC 28403 |
Second Address | Wilmington, NC 28403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08697 | BCBS OF NC (01) | NC |
T64510 | (02) |