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NPI 1174604268

NPI 1174604268 : MORGAN A SEUBOLD DC : ROLAND, OK

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General NPI Number Information
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    NPI Number           |    1174604268
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    Entity Type          |    Individual 
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    Provider Name        |    MORGAN A SEUBOLD DC
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    10/17/2006
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    Last Update Date     |    11/09/2007
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Provider Practice Location Address
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    Address Line         |    1022 E RAY FINE BLVD STE 4
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    City                 |    ROLAND
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    State                |    OK
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    Zip                  |    74954
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    Country              |    US
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    Telephone            |    918-427-3630
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    Fax                  |    918-427-3681
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Provider Business Mailing Address
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    Address Line         |    PO BOX 924 
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    City                 |    ROLAND
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    State                |    OK
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    Zip                  |    74954-0924
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    Country              |    US
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    Telephone            |    918-427-3630
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    Fax                  |    918-427-3681
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    111N00000X
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    Taxonomy Name        |    Chiropractor
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    License Number       |    20060642
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    License Number State |    OK
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