Provider Demographics
NPI:1073505871
Name:KIRKMAN, SARA M (DC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:M
Last Name:KIRKMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-1839
Mailing Address - Country:US
Mailing Address - Phone:608-837-7712
Mailing Address - Fax:608-825-6638
Practice Address - Street 1:1633 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-1839
Practice Address - Country:US
Practice Address - Phone:608-837-7712
Practice Address - Fax:608-825-6638
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3991111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38956500Medicaid
WI001635155Medicare ID - Type Unspecified
WI38956500Medicaid