Basic Information
| Provider Information | |||||||||
| NPI: | 1003139353 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEWELL | ||||||||
| FirstName: | TRENTON | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5606 SW 43RD AVE | ||||||||
| Address2: | |||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791095202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063512722 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5606 SW 43RD AVE | ||||||||
| Address2: | |||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791095202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063512722 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2010 | ||||||||
| LastUpdateDate: | 03/01/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 11047 | TX | Y | Chiropractic Providers | Chiropractor |
No ID Information.