Provider Demographics
NPI:1417953993
Name:SEYBERT, SHANLEY J (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANLEY
Middle Name:J
Last Name:SEYBERT
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 1:111 N PERRY ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16354-1624
Mailing Address - Country:US
Mailing Address - Phone:814-827-7114
Mailing Address - Fax:
Practice Address - Street 1:111 N PERRY ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16354-1624
Practice Address - Country:US
Practice Address - Phone:814-827-7114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001023L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006146080002Medicaid
PA0006146080002Medicaid
T28928Medicare UPIN