Provider Demographics
NPI:1902824584
Name:SISSKIND, JONATHAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:SISSKIND
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 1:63R BROADWAY
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-3120
Mailing Address - Country:US
Mailing Address - Phone:508-824-0303
Mailing Address - Fax:508-824-7303
Practice Address - Street 1:63R BROADWAY
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3120
Practice Address - Country:US
Practice Address - Phone:508-824-0303
Practice Address - Fax:508-824-7303
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2149111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA043379412OtherPRIVATE HEALTHCARE SYSTEM
MA002149OtherTUFTS
MA1041613OtherAMERICAN SPECIALTY HEALTH
MA350424OtherHARVARD PILGRIM (HPHC)
MA4400722OtherUNITED HEALTH CARE
MA391886617OtherTRIAD
MA646858OtherACN
MAY36568OtherBLUE CROSS/ BLUE SHIELD
MAHMO BLUEOtherBC/BS HMO
MA1612514Medicaid
MA791400OtherAETNA
Y45183Medicare ID - Type Unspecified
MA1612514Medicaid