Provider Demographics
NPI:1083725113
Name:ENSOR, SARA ELIZABETH (DC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ELIZABETH
Last Name:ENSOR
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 1:555 N RICE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:TX
Mailing Address - Zip Code:76531
Mailing Address - Country:US
Mailing Address - Phone:254-386-0060
Mailing Address - Fax:254-386-8565
Practice Address - Street 1:555 N RICE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:TX
Practice Address - Zip Code:76531
Practice Address - Country:US
Practice Address - Phone:254-386-0060
Practice Address - Fax:254-386-8565
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9843111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176469801Medicaid
TX608086OtherBLUE CROSS BLUE SHIELD
TX608086OtherBLUE CROSS BLUE SHIELD