Provider Demographics
NPI:1033270962
Name:JON SIBERT DC PA
Entity Type:Organization
Organization Name:JON SIBERT DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:DANTE
Authorized Official - Last Name:SIBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:830-792-6600
Mailing Address - Street 1:1001 WATER ST
Mailing Address - Street 2:SUITE D200
Mailing Address - City:KERRVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:78028-3566
Mailing Address - Country:US
Mailing Address - Phone:830-792-6600
Mailing Address - Fax:830-792-6602
Practice Address - Street 1:1001 WATER ST
Practice Address - Street 2:SUITE D200
Practice Address - City:KERRVILLE
Practice Address - State:TN
Practice Address - Zip Code:78028-3566
Practice Address - Country:US
Practice Address - Phone:830-792-6600
Practice Address - Fax:830-792-6602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8981111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8R7620OtherBLUE CROSS
003094Medicare PIN
U89301Medicare UPIN