Healthcare Provider Details

I. General information

NPI: 1548664238
Provider Name (Legal Business Name): ASHANNA SEVIN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 BROADWAY STE 29
ALAMEDA CA
94501-4663
US

IV. Provider business mailing address

1823 PACIFIC AVE APT C
ALAMEDA CA
94501-2679
US

V. Phone/Fax

Practice location:
  • Phone: 510-205-4122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number32340
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: