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General NPI Number Information
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NPI Number | 1306309737
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Entity Type | Individual
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Provider Name | DONLEY SISSOM L.AC., DIP.AC.
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Gender | Male
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Dates
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Enumeration Date | 04/11/2019
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Last Update Date | 04/11/2019
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Provider Practice Location Address
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Address Line | 1116 KEY ST STE 109
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City | BELLINGHAM
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State | WA
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Zip | 98225-5251
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Country | US
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Telephone | 360-306-9631
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Fax |
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Provider Business Mailing Address
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Address Line | 1924 CASCADIA LN
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City | BELLINGHAM
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State | WA
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Zip | 98225-4801
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Country | US
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Telephone | 360-306-9631
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | ACUP.AC.60948175
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License Number State | WA
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