Provider Demographics
NPI:1598757809
Name:SEBASTIAN, FORD SCOTT (DC)
Entity Type:Individual
Prefix:MR
First Name:FORD
Middle Name:SCOTT
Last Name:SEBASTIAN
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 1:280 N COAST HIGHWAY 101
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3254
Mailing Address - Country:US
Mailing Address - Phone:760-942-3321
Mailing Address - Fax:760-942-4468
Practice Address - Street 1:1351 ENCINITAS BLVD
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2845
Practice Address - Country:US
Practice Address - Phone:760-942-3321
Practice Address - Fax:760-942-4468
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20873111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU18459Medicare UPIN
CAU18459Medicare ID - Type Unspecified