Provider Demographics
NPI:1245280064
Name:SIEVERT, THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:SIEVERT
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 1:3880 COLONIAL BLVD STE 1A
Mailing Address - Street 2:SIEVERT CLINIC, LLC
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-1062
Mailing Address - Country:US
Mailing Address - Phone:239-936-1233
Mailing Address - Fax:239-936-8576
Practice Address - Street 1:3880 COLONIAL BLVD STE 1A
Practice Address - Street 2:SIEVERT CLINIC, LLC
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-1062
Practice Address - Country:US
Practice Address - Phone:239-936-1233
Practice Address - Fax:239-936-8576
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 3599111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88733OtherBLUE CROSS BLUE SHIELD
FLU21337Medicare UPIN
FLU21337Medicare ID - Type Unspecified
FL88733ZMedicare PIN