Provider Demographics
NPI:1629390414
Name:MED CHI PROFESSIONALS, LLC
Entity Type:Organization
Organization Name:MED CHI PROFESSIONALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:SEBAG
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:417-849-3231
Mailing Address - Street 1:PO BOX 841
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72602-0841
Mailing Address - Country:US
Mailing Address - Phone:417-849-3231
Mailing Address - Fax:870-743-5974
Practice Address - Street 1:816 N MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2915
Practice Address - Country:US
Practice Address - Phone:417-849-3231
Practice Address - Fax:870-743-5974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty