Provider Demographics
NPI:1952601114
Name:SEBORA, SHAWN TRACY (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:TRACY
Last Name:SEBORA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13161 HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:VA
Mailing Address - Zip Code:23314-3337
Mailing Address - Country:US
Mailing Address - Phone:757-848-6024
Mailing Address - Fax:
Practice Address - Street 1:11711 JEFFERSON AVE
Practice Address - Street 2:STE B
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2062
Practice Address - Country:US
Practice Address - Phone:757-594-9820
Practice Address - Fax:757-594-9823
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010456801111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor