MEDICARE: DR. RACHELLE LEIGH SEIDENBERG DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	11227	FL

General Provider Information

NPI Number	:	1538572656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RACHELLE LEIGH SEIDENBERG DC

Provider Business Mailing Address
First Line	:	6170 OLYMPIC CT
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-6782
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4904 CLYDE MORRIS BLVD STE A
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-9656
Country	:	US
Telephone Number	:	386-307-8207
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2014
Last Update Date	:	03/20/2025

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