Provider Demographics
NPI:1528052396
Name:SEVEDGE, MAUREEN LOUISE (DC)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:LOUISE
Last Name:SEVEDGE
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:PO BOX 1162
Mailing Address - Street 2:
Mailing Address - City:LAMESA
Mailing Address - State:TX
Mailing Address - Zip Code:79331-1162
Mailing Address - Country:US
Mailing Address - Phone:806-872-6534
Mailing Address - Fax:806-872-6535
Practice Address - Street 1:611 N AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:LAMESA
Practice Address - State:TX
Practice Address - Zip Code:79331-4531
Practice Address - Country:US
Practice Address - Phone:806-872-6534
Practice Address - Fax:806-872-6535
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
TX5021111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX602071Medicare ID - Type Unspecified