Provider Demographics
NPI:1548417850
Name:SANDRA G LEVY DC LLC
Entity Type:Organization
Organization Name:SANDRA G LEVY DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:G
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-991-5655
Mailing Address - Street 1:608 N MCKNIGHT RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-4911
Mailing Address - Country:US
Mailing Address - Phone:314-991-5655
Mailing Address - Fax:314-991-4872
Practice Address - Street 1:608 N MCKNIGHT RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-4911
Practice Address - Country:US
Practice Address - Phone:314-991-5655
Practice Address - Fax:314-991-4872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006343111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1699711739OtherPROVIDER ID
MOU55174Medicare UPIN
MO32437Medicare PIN