MEDICARE: DR. DANIEL JAMES SISCO N.D.

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	261Q00000X	Clinic/Center	000536	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902950645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL JAMES SISCO N.D.

Provider Business Mailing Address
First Line	:	3351 NE BROADWAY ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-1816
Country	:	US
Telephone Number	:	503-282-9222
Fax Number	:	503-282-8116

Provider Business Practice Location Address
First Line	:	3351 NE BROADWAY ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-1816
Country	:	US
Telephone Number	:	503-282-9222
Fax Number	:	503-282-8116

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	07/09/2007

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