Provider Demographics
NPI:1760033203
Name:RIEGEL-KESNER, SARA LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:LYNN
Last Name:RIEGEL-KESNER
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 1:215 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BRADLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60915-1269
Mailing Address - Country:US
Mailing Address - Phone:815-932-7800
Mailing Address - Fax:
Practice Address - Street 1:215 E NORTH ST
Practice Address - Street 2:
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915-1269
Practice Address - Country:US
Practice Address - Phone:815-932-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3240111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor