Provider Demographics
NPI:1942398698
Name:SEBESKY, BRIAN ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ROBERT
Last Name:SEBESKY
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 1:2301 WILDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-3947
Mailing Address - Country:US
Mailing Address - Phone:517-783-4545
Mailing Address - Fax:517-783-4544
Practice Address - Street 1:2301 WILDWOOD AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-3947
Practice Address - Country:US
Practice Address - Phone:517-783-4545
Practice Address - Fax:517-783-4544
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007519111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU67281Medicare UPIN
MIOM95910Medicare ID - Type Unspecified