Healthcare Provider Details

I. General information

NPI: 1679555676
Provider Name (Legal Business Name): DAVID REX SEGRAVES D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3417 W BETHEL AVE SUITE A
MUNCIE IN
47304-5472
US

IV. Provider business mailing address

3417 W. BETHEL AVE SUITE A
MUNCIE IN
47304-5473
US

V. Phone/Fax

Practice location:
  • Phone: 765-281-8883
  • Fax: 765-281-8884
Mailing address:
  • Phone: 765-281-8883
  • Fax: 765-281-8884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001214
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: