Provider Demographics
NPI:1831477975
Name:SEPULVEDA, NOEL HERIBERTO (DC, MS)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:HERIBERTO
Last Name:SEPULVEDA
Suffix:
Gender:M
Credentials:DC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1187 BROAD ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-4101
Mailing Address - Country:US
Mailing Address - Phone:203-870-8008
Mailing Address - Fax:203-330-8007
Practice Address - Street 1:80 ELM ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-4115
Practice Address - Country:US
Practice Address - Phone:203-870-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7.001890111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor