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General NPI Number Information
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NPI Number | 1447201660
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Entity Type | Organization
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Legal Business Name | SIEVERT CLINIC, LLC
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 09/23/2013
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Provider Practice Location Address
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Address Line | 3880 COLONIAL BLVD SUITE 1A
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City | FORT MYERS
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State | FL
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Zip | 33966-1062
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Country | US
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Telephone | 239-936-1233
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Fax | 239-936-8576
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Provider Business Mailing Address
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Address Line | 3880 COLONIAL BLVD SUITE 1A
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City | FORT MYERS
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State | FL
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Zip | 33966-1062
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Country | US
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Telephone | 239-936-1233
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Fax | 239-936-8576
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS D. SIEVERT
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Credential | D.C.
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Telephone | 239-936-1233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS9565
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP2826072
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH3599
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License Number State | FL
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