=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598944944
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEUBOLD FAMILY CHIROPRACTIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2007
-----------------------------------------------------
Last Update Date | 11/06/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 311 4 E RAY FINE BLVD SUITE4
-----------------------------------------------------
City | ROLAND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-427-3630
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 924
-----------------------------------------------------
City | ROLAND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74954-0924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-427-3630
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MORGAN ARMBUSTER SEUBOLD
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 918-427-3630
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3745
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------