Provider Demographics
NPI:1346216264
Name:SEA, DOUGLAS D (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:D
Last Name:SEA
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 1:2523 S SHIRLEY AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-4324
Mailing Address - Country:US
Mailing Address - Phone:605-361-6706
Mailing Address - Fax:605-362-8907
Practice Address - Street 1:2523 S SHIRLEY AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-4324
Practice Address - Country:US
Practice Address - Phone:605-361-6706
Practice Address - Fax:605-362-8907
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD679111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS2518Medicare ID - Type Unspecified