Healthcare Provider Details

I. General information

NPI: 1649301458
Provider Name (Legal Business Name): SEDERBERG CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 HARRISON ST
BATESVILLE AR
72501-7416
US

IV. Provider business mailing address

2121 HARRISON ST
BATESVILLE AR
72501-7416
US

V. Phone/Fax

Practice location:
  • Phone: 870-793-7370
  • Fax: 870-793-7370
Mailing address:
  • Phone: 870-793-7370
  • Fax: 870-793-7370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1077
License Number StateAR

VIII. Authorized Official

Name: DR. RICHARD L SEDERBERG
Title or Position: PRESIDENT
Credential: DC
Phone: 870-793-7370