Provider Demographics
NPI:1871782151
Name:SIBERT, JON DANTE (DC)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:DANTE
Last Name:SIBERT
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 1:133 W WATER ST
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-5243
Mailing Address - Country:US
Mailing Address - Phone:830-792-6600
Mailing Address - Fax:830-792-6602
Practice Address - Street 1:1001 WATER ST
Practice Address - Street 2:SUITE D200
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-3523
Practice Address - Country:US
Practice Address - Phone:830-792-6600
Practice Address - Fax:830-792-6602
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4273111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R7620OtherBLUE CROSS
TXU89301Medicare UPIN
TX003094Medicare UPIN
TX8R7620OtherBLUE CROSS