Provider Demographics
NPI:1518158013
Name:VICTOR A. SAGE, DC P.C.
Entity Type:Organization
Organization Name:VICTOR A. SAGE, DC P.C.
Other - Org Name:SAGE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAGE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:610-325-6037
Mailing Address - Street 1:2002 SPROUL RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3510
Mailing Address - Country:US
Mailing Address - Phone:610-325-6037
Mailing Address - Fax:610-325-6039
Practice Address - Street 1:2002 SPROUL RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3510
Practice Address - Country:US
Practice Address - Phone:610-325-6037
Practice Address - Fax:610-325-6039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-009493111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAV10515Medicare UPIN
PASA-104438Medicare PIN