Provider Demographics
NPI:1629088554
Name:SEIBERT, NELSON KEITH (DC)
Entity Type:Individual
Prefix:DR
First Name:NELSON
Middle Name:KEITH
Last Name:SEIBERT
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 1:123 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-1114
Mailing Address - Country:US
Mailing Address - Phone:419-732-3189
Mailing Address - Fax:419-734-1963
Practice Address - Street 1:123 E 2ND ST
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-1114
Practice Address - Country:US
Practice Address - Phone:419-732-3189
Practice Address - Fax:419-734-1963
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH840111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0454539Medicaid
OH2509843OtherAETNA PROVIDER #
OH000000130874OtherANTHEM BCBS
OH04936OtherPARAMOUNT PROVIDER #
OH2509843OtherAETNA PROVIDER #
OH000000130874OtherANTHEM BCBS