Provider Demographics
NPI:1467660308
Name:SEAGREN, JONATHAN R (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:R
Last Name:SEAGREN
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 1:16016 MANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-2820
Mailing Address - Country:US
Mailing Address - Phone:402-884-0026
Mailing Address - Fax:
Practice Address - Street 1:110 S 77TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4577
Practice Address - Country:US
Practice Address - Phone:402-397-0949
Practice Address - Fax:402-397-0968
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1259111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor