Provider Demographics
NPI:1144928177
Name:M & B SEBASTIAN LLC
Entity type:Organization
Organization Name:M & B SEBASTIAN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SEBASTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:412-608-4403
Mailing Address - Street 1:6025 GRAND SONATA AVE
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-5618
Mailing Address - Country:US
Mailing Address - Phone:412-608-4403
Mailing Address - Fax:
Practice Address - Street 1:3310 W CYPRESS ST STE 207
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5038
Practice Address - Country:US
Practice Address - Phone:813-374-2930
Practice Address - Fax:813-374-8455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1700384633OtherNPI