Provider Demographics
NPI:1417088410
Name:KIRSTEN SAGE CHIROPRACTIC PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:KIRSTEN SAGE CHIROPRACTIC PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:SAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-753-2157
Mailing Address - Street 1:531 ENCINITAS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3741
Mailing Address - Country:US
Mailing Address - Phone:760-753-2157
Mailing Address - Fax:760-753-8108
Practice Address - Street 1:531 ENCINITAS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3741
Practice Address - Country:US
Practice Address - Phone:760-753-2157
Practice Address - Fax:760-753-8108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27-1962111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty