Provider Demographics
NPI:1508859604
Name:AUGUSTINE, SHERRI A C (DC)
Entity Type:Individual
Prefix:MRS
First Name:SHERRI
Middle Name:A C
Last Name:AUGUSTINE
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 1:10521 N PORT WASHINGTON RD
Mailing Address - Street 2:STE 130
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-5584
Mailing Address - Country:US
Mailing Address - Phone:262-241-3434
Mailing Address - Fax:262-241-3903
Practice Address - Street 1:10521 N PORT WASHINGTON RD
Practice Address - Street 2:STE 130
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5584
Practice Address - Country:US
Practice Address - Phone:262-241-3434
Practice Address - Fax:262-241-3903
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3112012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U34880Medicare UPIN