Provider Demographics
NPI:1093573917
Name:SEBASTIAN, TONY
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:SEBASTIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 CHALEUR BAY DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-4184
Mailing Address - Country:US
Mailing Address - Phone:214-392-2143
Mailing Address - Fax:
Practice Address - Street 1:10945 ESTATE LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-2317
Practice Address - Country:US
Practice Address - Phone:469-917-9208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor