Healthcare Provider Details

I. General information

NPI: 1891441903
Provider Name (Legal Business Name): DANIEL J SENGENBERGER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2022
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 SISKIYOU BLVD STE 7
ASHLAND OR
97520-2125
US

IV. Provider business mailing address

1316 E MAIN ST
MEDFORD OR
97504-7561
US

V. Phone/Fax

Practice location:
  • Phone: 541-482-2920
  • Fax:
Mailing address:
  • Phone: 541-622-5609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL J SENGENBERGER
Title or Position: OWNER
Credential: DO
Phone: 541-622-5609