Provider Demographics
NPI:1053409821
Name:CHRISTOPHER SIENES CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:CHRISTOPHER SIENES CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:P
Authorized Official - Last Name:MATHRE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:209-223-2225
Mailing Address - Street 1:665 NEW YORK RANCH RD STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642-9332
Mailing Address - Country:US
Mailing Address - Phone:209-223-2225
Mailing Address - Fax:209-223-2976
Practice Address - Street 1:665 NEW YORK RANCH RD STE 1
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-9332
Practice Address - Country:US
Practice Address - Phone:209-223-2225
Practice Address - Fax:209-223-2976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0182610111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ30034ZMedicare PIN