Provider Demographics
NPI:1790945012
Name:SE HEALTH SERVICES
Entity Type:Organization
Organization Name:SE HEALTH SERVICES
Other - Org Name:LIBERTY HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:SYVRUD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-388-3455
Mailing Address - Street 1:8225 BRUTON RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217-1903
Mailing Address - Country:US
Mailing Address - Phone:214-388-3455
Mailing Address - Fax:214-388-1112
Practice Address - Street 1:8225 BRUTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-1903
Practice Address - Country:US
Practice Address - Phone:214-388-3455
Practice Address - Fax:214-388-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2503111N00000X
TX10858111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty