Healthcare Provider Details

I. General information

NPI: 1205124013
Provider Name (Legal Business Name): JACOB RYAN SEGEBART D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 07/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 COURT ST
HARLAN IA
51537-1439
US

IV. Provider business mailing address

1305 BRUMMER DR
DENISON IA
51442-2828
US

V. Phone/Fax

Practice location:
  • Phone: 712-733-4545
  • Fax:
Mailing address:
  • Phone: 712-790-1497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number007440
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: