Healthcare Provider Details

I. General information

NPI: 1598944944
Provider Name (Legal Business Name): SEUBOLD FAMILY CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 4 E RAY FINE BLVD SUITE4
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:
Mailing address:
  • Phone: 918-427-3630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3745
License Number StateOK

VIII. Authorized Official

Name: DR. MORGAN ARMBUSTER SEUBOLD
Title or Position: PRESIDENT
Credential: D.C.
Phone: 918-427-3630