Provider Demographics
NPI:1962513077
Name:SEUBOLD, HENRY LIND (DC)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:LIND
Last Name:SEUBOLD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 EUPER LANE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903
Mailing Address - Country:US
Mailing Address - Phone:479-484-7200
Mailing Address - Fax:479-484-7991
Practice Address - Street 1:5600 EUPER LANE
Practice Address - Street 2:SEUBOLD CHIRPRACTIC CLINIC
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903
Practice Address - Country:US
Practice Address - Phone:479-484-7200
Practice Address - Fax:479-484-7991
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR937111N00000X
OK2102111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
57697OtherMEDICARE CLINIC #
59094Medicare ID - Type Unspecified
T20565Medicare UPIN