Healthcare Provider Details

I. General information

NPI: 1992825517
Provider Name (Legal Business Name): JOSEPH H. SEVLIE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 12/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1626 W. 3RD ST.
RED WING MN
55066
US

IV. Provider business mailing address

1626 W. 3RD ST.
RED WING MN
55066
US

V. Phone/Fax

Practice location:
  • Phone: 651-388-1211
  • Fax: 651-388-1311
Mailing address:
  • Phone: 651-388-1211
  • Fax: 651-388-1311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1966
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number1966
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: