Provider Demographics
NPI:1679555676
Name:SEGRAVES, DAVID REX (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:REX
Last Name:SEGRAVES
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 1:3417 W. BETHEL AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-5473
Mailing Address - Country:US
Mailing Address - Phone:765-281-8883
Mailing Address - Fax:765-281-8884
Practice Address - Street 1:3417 W BETHEL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-5472
Practice Address - Country:US
Practice Address - Phone:765-281-8883
Practice Address - Fax:765-281-8884
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001214111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10098710Medicaid
IN10098710Medicaid