Provider Demographics
NPI:1295016723
Name:SEIBERT, SHANE (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:
Last Name:SEIBERT
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 1:1382 E ALLUVIAL AVE
Mailing Address - Street 2:STE #106
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2608
Mailing Address - Country:US
Mailing Address - Phone:559-432-9700
Mailing Address - Fax:559-432-9701
Practice Address - Street 1:1382 E ALLUVIAL AVE
Practice Address - Street 2:STE #106
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2608
Practice Address - Country:US
Practice Address - Phone:559-432-9700
Practice Address - Fax:559-432-9701
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32064111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor