Provider Demographics
NPI:1871598524
Name:SEMBALUK, TODD MARC DWAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:MARC DWAYNE
Last Name:SEMBALUK
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 1:7141 W THOMAS RD
Mailing Address - Street 2:STE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85033-5500
Mailing Address - Country:US
Mailing Address - Phone:623-849-3003
Mailing Address - Fax:623-873-2119
Practice Address - Street 1:7141 W THOMAS RD
Practice Address - Street 2:STE 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-5500
Practice Address - Country:US
Practice Address - Phone:623-849-3003
Practice Address - Fax:623-873-2119
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-19
Last Update Date:2007-07-09
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
AZ5776111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5776Medicare UPIN
AZ21696Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER