Provider Demographics
NPI:1164695078
Name:TYBERG, SETH DAVID (DC)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:DAVID
Last Name:TYBERG
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 1:4228 POWER DR NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-5102
Mailing Address - Country:US
Mailing Address - Phone:218-444-2117
Mailing Address - Fax:218-444-2317
Practice Address - Street 1:4228 POWER DR NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-5102
Practice Address - Country:US
Practice Address - Phone:218-444-2117
Practice Address - Fax:218-444-2317
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5116111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor