Provider Demographics
NPI:1205857471
Name:BEGOVIC, SANELA (DC)
Entity Type:Individual
Prefix:DR
First Name:SANELA
Middle Name:
Last Name:BEGOVIC
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 1:5218 GRAVOIS AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-2310
Mailing Address - Country:US
Mailing Address - Phone:314-752-5992
Mailing Address - Fax:314-351-7773
Practice Address - Street 1:5218 GRAVOIS AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63116-2310
Practice Address - Country:US
Practice Address - Phone:314-752-5992
Practice Address - Fax:314-351-7773
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005000497111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOV04976Medicare UPIN