Provider Demographics
NPI:1033218052
Name:SAGERTY, SHIRLEY FAY (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:FAY
Last Name:SAGERTY
Suffix:
Gender:F
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2434 N WOODLAWN BLVD
Mailing Address - Street 2:STE 170
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-3959
Mailing Address - Country:US
Mailing Address - Phone:316-683-5490
Mailing Address - Fax:316-683-0630
Practice Address - Street 1:2434 N WOODLAWN BLVD
Practice Address - Street 2:STE 170
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-3959
Practice Address - Country:US
Practice Address - Phone:316-683-5490
Practice Address - Fax:316-683-0630
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04237111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS014152Medicare ID - Type Unspecified