Provider Demographics
NPI:1710036744
Name:SIBILLA, DANA WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:WILLIAM
Last Name:SIBILLA
Suffix:
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 1:1934 NE BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1502
Mailing Address - Country:US
Mailing Address - Phone:503-280-9759
Mailing Address - Fax:503-280-9798
Practice Address - Street 1:1934 NE BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1502
Practice Address - Country:US
Practice Address - Phone:503-280-9759
Practice Address - Fax:503-280-9798
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-2971111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR101830Medicare ID - Type Unspecified
ORU70851Medicare UPIN