Provider Demographics
NPI:1356631329
Name:SAZAMA FAMILY CHIROPRACTIC & WELLNESS PA
Entity Type:Organization
Organization Name:SAZAMA FAMILY CHIROPRACTIC & WELLNESS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD OF DIRECTORS
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAZAMA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:308-750-4891
Mailing Address - Street 1:5638 RUSH LAKE CT
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-8716
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7111 FORTHUN RD STE 200
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8596
Practice Address - Country:US
Practice Address - Phone:218-454-4545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty