Healthcare Provider Details

I. General information

NPI: 1265790992
Provider Name (Legal Business Name): ANDREW BRYAN SEPPALA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 04/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1297 KILBERY LN
NORTH AURORA IL
60542-4604
US

IV. Provider business mailing address

1297 KILBERY LN
NORTH AURORA IL
60542-4604
US

V. Phone/Fax

Practice location:
  • Phone: 952-239-6235
  • Fax:
Mailing address:
  • Phone: 952-239-6235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5665
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number038012287
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: