MEDICARE: DR. MARK STEVEN SIELSKI D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	38MC00410600	NJ

General Provider Information

NPI Number	:	1538209440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK STEVEN SIELSKI D.C.

Provider Business Mailing Address
First Line	:	1108 SALEM AVE
Second Line	:
City	:	HILLSIDE
State	:	NJ
Zip	:	07205-2835
Country	:	US
Telephone Number	:	908-353-3486
Fax Number	:

Provider Business Practice Location Address
First Line	:	227 GROVE ST
Second Line	:
City	:	NORTH PLAINFIELD
State	:	NJ
Zip	:	07060-4742
Country	:	US
Telephone Number	:	908-756-0800
Fax Number	:	908-756-8519

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/08/2007

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