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General NPI Number Information
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NPI Number | 1629424288
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Entity Type | Organization
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Legal Business Name | C1C2 PLLC
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Dates
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Enumeration Date | 05/12/2016
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Last Update Date | 05/12/2016
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Provider Practice Location Address
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Address Line | 1426 N MAIN ST
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City | TAYLOR
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State | TX
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Zip | 76574-3032
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Country | US
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Telephone | 512-352-1300
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Fax | 512-352-1301
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Provider Business Mailing Address
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Address Line | 1426 N MAIN ST
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City | TAYLOR
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State | TX
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Zip | 76574-3032
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Country | US
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Telephone | 512-352-1300
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Fax | 512-352-1301
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Authorized Official
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Title or Position | DOCTOR
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Name | SEAN P. SEIVERT
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Credential | D.C.
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Telephone | 512-352-1300
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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 | 10908
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License Number State | TX
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