Basic Information
| Provider Information | |||||||||
| NPI: | 1336119924 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEIFRIED | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7252 N BLACK ROCK TRL | ||||||||
| Address2: | |||||||||
| City: | PARADISE VALLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852532803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804738664 | ||||||||
| FaxNumber: | 6028895834 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 N CENTRAL AVE | ||||||||
| Address2: | SUITE #775 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850044424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028895833 | ||||||||
| FaxNumber: | 6028895834 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111NS0005X | 5497 | AZ | Y | Chiropractic Providers | Chiropractor | Sports Physician |
ID Information
| ID | Type | State | Issuer | Description | 5497 | 01 | AZ | STATE BOARD LICENSE NUMBE | OTHER |