Provider Demographics
NPI:1720301880
Name:SEIFERT, JUSTIN ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:ROBERT
Last Name:SEIFERT
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 1:4420 RICHMOND CT
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-2232
Mailing Address - Country:US
Mailing Address - Phone:563-340-8885
Mailing Address - Fax:563-265-8292
Practice Address - Street 1:755 W IOWA 80 RD
Practice Address - Street 2:
Practice Address - City:WALCOTT
Practice Address - State:IA
Practice Address - Zip Code:52773-8572
Practice Address - Country:US
Practice Address - Phone:563-468-5512
Practice Address - Fax:563-265-8292
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007287111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1720301880Medicaid