1568582914 NPI number — DR. SEAN SELLARS D.C.

Table of content: DR. SEAN SELLARS D.C. (NPI 1568582914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568582914 NPI number — DR. SEAN SELLARS D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SELLARS
Provider First Name:
SEAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568582914
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
461 DEL PRADO BLVD S STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAPE CORAL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33990-2681
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-800-4149
Provider Business Mailing Address Fax Number:
239-800-4152

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
461 DEL PRADO BLVD S STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAPE CORAL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33990-2681
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-800-4149
Provider Business Practice Location Address Fax Number:
239-800-4152
Provider Enumeration Date:
03/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH8937 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0007005747 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1568582914 . This is a "INTEGRAL QUALITY CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1568582914 . This is a "HUMANA/CHOICE CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 88749 . This is a "BLUE CROSS / BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2837966 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 001208500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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