Provider Demographics
NPI:1831885219
Name:EBEL, SETH MATTHEW (LAC)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:MATTHEW
Last Name:EBEL
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 ROCKLEDGE RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-2562
Mailing Address - Country:US
Mailing Address - Phone:773-991-9455
Mailing Address - Fax:
Practice Address - Street 1:515 ROCKLEDGE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-2562
Practice Address - Country:US
Practice Address - Phone:773-991-9455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS23-00080171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist