Provider Demographics
NPI:1285632588
Name:SEIDMAN, MICHAEL BARRY (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BARRY
Last Name:SEIDMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:BARRY
Other - Last Name:SEIDMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC, MSW
Mailing Address - Street 1:741 BRADY ST.
Mailing Address - Street 2:PALMER CENTER FOR CHIROPRACTIC RESEARCH
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-5209
Mailing Address - Country:US
Mailing Address - Phone:563-505-8133
Mailing Address - Fax:563-884-5227
Practice Address - Street 1:741 BRADY ST
Practice Address - Street 2:PALMER CHIROPRACTIC COLLEGE
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-5209
Practice Address - Country:US
Practice Address - Phone:414-884-5303
Practice Address - Fax:563-884-5227
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1946012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38846000Medicaid
WIT63297Medicare UPIN