Provider Demographics
NPI:1780960146
Name:SHANE SEIBERT, D.C. A PROFESSIONAL CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:SHANE SEIBERT, D.C. A PROFESSIONAL CHIROPRACTIC CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEIBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:559-432-9700
Mailing Address - Street 1:1382 E ALLUVIAL AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2608
Mailing Address - Country:US
Mailing Address - Phone:559-432-9700
Mailing Address - Fax:559-432-9701
Practice Address - Street 1:1382 E ALLUVIAL AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2608
Practice Address - Country:US
Practice Address - Phone:559-432-9700
Practice Address - Fax:559-432-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty