Healthcare Provider Details

I. General information

NPI: 1932114501
Provider Name (Legal Business Name): RICHARD L SEDERBERG DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/08/2007
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:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: