Provider Demographics
NPI:1235103656
Name:SIEBERT, EVERT GENE (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:EVERT
Middle Name:GENE
Last Name:SIEBERT
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 ELM ST
Mailing Address - Street 2:APT 3
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-2046
Mailing Address - Country:US
Mailing Address - Phone:812-249-9468
Mailing Address - Fax:
Practice Address - Street 1:7TH STREET
Practice Address - Street 2:INDIANA STATE UNIVERSITY, ARENA BUILDING
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807
Practice Address - Country:US
Practice Address - Phone:812-249-9468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001269A390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program