Provider Demographics
NPI:1346460557
Name:CHEN, SARAH J (DC)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:J
Last Name:CHEN
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 1:5457 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1703
Mailing Address - Country:US
Mailing Address - Phone:773-506-7886
Mailing Address - Fax:
Practice Address - Street 1:5457 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1703
Practice Address - Country:US
Practice Address - Phone:773-506-7886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL352-780Medicare ID - Type Unspecified
U44189Medicare UPIN