Provider Demographics
NPI:1588636047
Name:SORELL, SEAN ANTHONY (DC)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:ANTHONY
Last Name:SORELL
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 1:630 POYNTZ AVENUE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-6041
Mailing Address - Country:US
Mailing Address - Phone:785-776-7568
Mailing Address - Fax:
Practice Address - Street 1:630 POYNTZ AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-6041
Practice Address - Country:US
Practice Address - Phone:785-776-7568
Practice Address - Fax:785-776-2001
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104057111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS059967Medicare ID - Type Unspecified
KSU30472Medicare UPIN