Healthcare Provider Details

I. General information

NPI: 1831794213
Provider Name (Legal Business Name): KATELYN RENEE SEABA DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 RED TAFFY WAY
LEXINGTON SC
29073-8781
US

IV. Provider business mailing address

514 RED TAFFY WAY
LEXINGTON SC
29073-8781
US

V. Phone/Fax

Practice location:
  • Phone: 319-331-2006
  • Fax:
Mailing address:
  • Phone: 319-331-2006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4602
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number4602
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number4602
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: