Provider Demographics
NPI:1477662146
Name:SEBBAS, LEO VIC (DC)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:VIC
Last Name:SEBBAS
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 1:9480 BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-5822
Mailing Address - Country:US
Mailing Address - Phone:909-980-1400
Mailing Address - Fax:909-987-5258
Practice Address - Street 1:9480 BASELINE RD
Practice Address - Street 2:
Practice Address - City:ALTA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91701-5822
Practice Address - Country:US
Practice Address - Phone:909-980-1400
Practice Address - Fax:909-987-5258
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 10960111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC 10960OtherSTATE LICENSE NUMBER
CADC 10960Medicare ID - Type Unspecified