Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 5497 | AZ |
NPI | 1336119924 |
---|---|
Provider Name | Dr. Michael Seifried |
First Address | Paradise Valley, AZ 85253-2803 |
Second Address | Phoenix, AZ 85004-4424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5497 | STATE BOARD LICENSE NUMBE (01) | AZ |