Provider Demographics
NPI:1144388323
Name:SEUBOLD CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:SEUBOLD CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:SEUBOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-484-7200
Mailing Address - Street 1:5600 EUPER LN
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3236
Mailing Address - Country:US
Mailing Address - Phone:479-484-7200
Mailing Address - Fax:
Practice Address - Street 1:5600 EUPER LN
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3236
Practice Address - Country:US
Practice Address - Phone:479-484-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR772111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ART-20710Medicare UPIN