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General NPI Number Information
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NPI Number | 1669779831
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Entity Type | Individual
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Provider Name | CHARLES S SIDUN DC
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Gender | Male
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Dates
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Enumeration Date | 02/23/2011
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Last Update Date | 02/23/2011
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Provider Practice Location Address
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Address Line | 3019 MARYLAND AVE
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City | NORTH VERSAILLES
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State | PA
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Zip | 15137-1485
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Country | US
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Telephone | 412-823-9300
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Fax |
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Provider Business Mailing Address
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Address Line | 3019 MARYLAND AVE
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City | NORTH VERSAILLES
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State | PA
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Zip | 15137
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Country | US
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Telephone | 412-823-9300
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC002544L
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License Number State | PA
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