Provider Demographics
NPI:1376758649
Name:SESCO CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:SESCO CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SESCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-524-3030
Mailing Address - Street 1:1527 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-2631
Mailing Address - Country:US
Mailing Address - Phone:419-524-3030
Mailing Address - Fax:419-756-1142
Practice Address - Street 1:1527 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-2631
Practice Address - Country:US
Practice Address - Phone:419-524-3030
Practice Address - Fax:419-756-1142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1339111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9308011OtherMEDICARE ID