Healthcare Provider Details

I. General information

NPI: 1417953993
Provider Name (Legal Business Name): SHANLEY J SEYBERT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N PERRY ST
TITUSVILLE PA
16354-1624
US

IV. Provider business mailing address

111 N PERRY ST
TITUSVILLE PA
16354-1624
US

V. Phone/Fax

Practice location:
  • Phone: 814-827-7114
  • Fax:
Mailing address:
  • Phone: 814-827-7114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC001023L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: