Individual
DUSTIN SEIBEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
821 DIANNA DR, LODI, CA 95240-4634
(209) 327-6326
Mailing address
821 DIANNA DR, LODI, CA 95240-4634
(209) 327-6326
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000001324
CA
Other
Enumeration date
06/10/2019
Last updated
06/10/2019
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