Provider Demographics
NPI:1679840540
Name:SEGEBART CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:SEGEBART CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:SEGEBART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-790-1497
Mailing Address - Street 1:141 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:IA
Mailing Address - Zip Code:51442-2457
Mailing Address - Country:US
Mailing Address - Phone:712-263-6546
Mailing Address - Fax:
Practice Address - Street 1:141 N 7TH ST
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:IA
Practice Address - Zip Code:51442-2457
Practice Address - Country:US
Practice Address - Phone:712-263-6546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007440111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty