Provider Demographics
NPI:1871631127
Name:SAUTER, MARK JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOHN
Last Name:SAUTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 STEELE ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ALGOMA
Mailing Address - State:WI
Mailing Address - Zip Code:54201-1266
Mailing Address - Country:US
Mailing Address - Phone:920-304-3270
Mailing Address - Fax:
Practice Address - Street 1:305 STEELE ST
Practice Address - Street 2:SUITE 105
Practice Address - City:ALGOMA
Practice Address - State:WI
Practice Address - Zip Code:54201-1266
Practice Address - Country:US
Practice Address - Phone:920-304-3270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2736012111N00000X
IN08001289111N00000X
MI2301005847111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor