Provider Demographics
NPI:1225263247
Name:COSTIANIS, SARAH KATHERINE (DC)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:KATHERINE
Last Name:COSTIANIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:KATIE
Other - Last Name:LEMLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:421 N MARION ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1813
Mailing Address - Country:US
Mailing Address - Phone:708-407-1080
Mailing Address - Fax:800-360-7697
Practice Address - Street 1:167 N MARION ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1032
Practice Address - Country:US
Practice Address - Phone:708-407-1080
Practice Address - Fax:800-360-7697
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38011422111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor