Provider Demographics
NPI:1033103460
Name:SELLERS, BART C (DC)
Entity Type:Individual
Prefix:
First Name:BART
Middle Name:C
Last Name:SELLERS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 SAINT ANN DR
Mailing Address - Street 2:STE 2
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3219
Mailing Address - Country:US
Mailing Address - Phone:985-624-9888
Mailing Address - Fax:985-624-2572
Practice Address - Street 1:221 SAINT ANN DR
Practice Address - Street 2:STE 2
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3219
Practice Address - Country:US
Practice Address - Phone:985-624-9888
Practice Address - Fax:985-624-2572
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA932111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1953601Medicaid
LA1953601Medicaid
U30034Medicare UPIN