Provider Demographics
NPI:1891836565
Name:SIELAWA, JESSICA ANN (DC)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ANN
Last Name:SIELAWA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 BURNS AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-2510
Mailing Address - Country:US
Mailing Address - Phone:315-224-4085
Mailing Address - Fax:
Practice Address - Street 1:6607 KINNE RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13214-1871
Practice Address - Country:US
Practice Address - Phone:315-682-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor