Provider Demographics
NPI:1164449195
Name:SISSON, WILLIAM ELIASON JR (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ELIASON
Last Name:SISSON
Suffix:JR
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 1:4706 OLEANDER DRIVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403
Mailing Address - Country:US
Mailing Address - Phone:910-392-3770
Mailing Address - Fax:910-313-6711
Practice Address - Street 1:4706 OLEANDER DRIVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403
Practice Address - Country:US
Practice Address - Phone:910-392-3770
Practice Address - Fax:910-313-6711
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1539111N00000X
CA17334111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08697OtherBCBS OF NC
NC244490Medicare ID - Type Unspecified
T64510Medicare UPIN