Provider Demographics
NPI:1821275686
Name:YACKLEY-PLOEGER, SARAH ELIZABETH (DC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH
Last Name:YACKLEY-PLOEGER
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 1:1068 LAKE ST S
Mailing Address - Street 2:SUITE 15
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-2639
Mailing Address - Country:US
Mailing Address - Phone:952-240-9058
Mailing Address - Fax:
Practice Address - Street 1:1068 LAKE ST S
Practice Address - Street 2:SUITE 15
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-2639
Practice Address - Country:US
Practice Address - Phone:952-240-9058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5072111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor