Provider Demographics
NPI:1205124013
Name:SEGEBART, JACOB RYAN (DC)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:RYAN
Last Name:SEGEBART
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 1:1305 BRUMMER DR
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:IA
Mailing Address - Zip Code:51442-2828
Mailing Address - Country:US
Mailing Address - Phone:712-790-1497
Mailing Address - Fax:
Practice Address - Street 1:515 COURT ST
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:IA
Practice Address - Zip Code:51537-1439
Practice Address - Country:US
Practice Address - Phone:712-733-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007440111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor