Healthcare Provider Details

I. General information

NPI: 1174604268
Provider Name (Legal Business Name): MORGAN A SEUBOLD DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 E RAY FINE BLVD STE 4
ROLAND OK
74954
US

IV. Provider business mailing address

PO BOX 924
ROLAND OK
74954-0924
US

V. Phone/Fax

Practice location:
  • Phone: 918-427-3630
  • Fax: 918-427-3681
Mailing address:
  • Phone: 918-427-3630
  • Fax: 918-427-3681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number20060642
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: