Provider Demographics
NPI:1902879059
Name:SIGAFOOSE-JACKSON, SELINA MONTOYA (DC)
Entity Type:Individual
Prefix:DR
First Name:SELINA
Middle Name:MONTOYA
Last Name:SIGAFOOSE-JACKSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2413
Mailing Address - Country:US
Mailing Address - Phone:717-757-5731
Mailing Address - Fax:717-757-1989
Practice Address - Street 1:2816 E MARKET ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-2413
Practice Address - Country:US
Practice Address - Phone:717-757-5731
Practice Address - Fax:717-757-1989
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004207L111N00000X
FLCH 6143111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor