Provider Demographics
NPI:1134698681
Name:SPROUT FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:SPROUT FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KALISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAWYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-202-0025
Mailing Address - Street 1:960 STUART CT
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-5155
Mailing Address - Country:US
Mailing Address - Phone:920-202-0025
Mailing Address - Fax:
Practice Address - Street 1:652 W RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-1254
Practice Address - Country:US
Practice Address - Phone:920-710-1811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-14
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty