Healthcare Provider Details

I. General information

NPI: 1902929888
Provider Name (Legal Business Name): JASON J SEFA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2007
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 SHELDON AVE
CLIO MI
48420-1418
US

IV. Provider business mailing address

137 SHELDON AVE
CLIO MI
48420-1418
US

V. Phone/Fax

Practice location:
  • Phone: 810-513-1703
  • Fax:
Mailing address:
  • Phone: 810-513-1703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301008411
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: