Healthcare Provider Details

I. General information

NPI: 1336119924
Provider Name (Legal Business Name): MICHAEL SEIFRIED DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 N CENTRAL AVE SUITE #775
PHOENIX AZ
85004-4424
US

IV. Provider business mailing address

7252 N BLACK ROCK TRL
PARADISE VALLEY AZ
85253-2803
US

V. Phone/Fax

Practice location:
  • Phone: 602-889-5833
  • Fax: 602-889-5834
Mailing address:
  • Phone: 480-473-8664
  • Fax: 602-889-5834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number5497
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: