Provider Demographics
NPI:1417738527
Name:SEBASTIAN, CHIP JULIAN
Entity Type:Individual
Prefix:MR
First Name:CHIP
Middle Name:JULIAN
Last Name:SEBASTIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3352 SMOKY MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-1057
Mailing Address - Country:US
Mailing Address - Phone:859-421-1469
Mailing Address - Fax:
Practice Address - Street 1:3352 SMOKY MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-1057
Practice Address - Country:US
Practice Address - Phone:859-421-1469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY109527225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist