Provider Demographics
NPI:1104853977
Name:SAUER-DRAEGER, ELLEN MAUREEN (DC)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:MAUREEN
Last Name:SAUER-DRAEGER
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 1:239 SUPERIOR STREET
Mailing Address - Street 2:
Mailing Address - City:ANTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54409-1860
Mailing Address - Country:US
Mailing Address - Phone:715-623-4800
Mailing Address - Fax:715-623-6466
Practice Address - Street 1:239 SUPERIOR STREET
Practice Address - Street 2:
Practice Address - City:ANTIGO
Practice Address - State:WI
Practice Address - Zip Code:54409-1860
Practice Address - Country:US
Practice Address - Phone:715-623-4800
Practice Address - Fax:715-623-6466
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3137012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38883700Medicaid
WI38883700Medicaid