Provider Demographics
NPI:1477815918
Name:AGER CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:AGER CHIROPRACTIC LLC
Other - Org Name:AGER CHIROPRACTIC WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:AGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-279-0405
Mailing Address - Street 1:948 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-2039
Mailing Address - Country:US
Mailing Address - Phone:608-279-0405
Mailing Address - Fax:
Practice Address - Street 1:948 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-2039
Practice Address - Country:US
Practice Address - Phone:608-279-0405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4289-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty