Provider Demographics
NPI:1790371599
Name:SEBO, TROY (DC)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:SEBO
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 1:4900 WINDHAVEN PKWY APT 1304
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-6085
Mailing Address - Country:US
Mailing Address - Phone:469-986-7718
Mailing Address - Fax:
Practice Address - Street 1:1201 E MAIN ST STE 240
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-3960
Practice Address - Country:US
Practice Address - Phone:214-785-7973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-15
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14197111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14197OtherDC LICENSE