Provider Demographics
NPI:1295915221
Name:SCHWARTZ, SANDRA SUE (DC)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:SUE
Last Name:SCHWARTZ
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 1:1401B SOUTH STATE STREET
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-6877
Mailing Address - Country:US
Mailing Address - Phone:217-351-2021
Mailing Address - Fax:217-351-1740
Practice Address - Street 1:1401B SOUTH STATE STREET
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-6877
Practice Address - Country:US
Practice Address - Phone:217-351-2021
Practice Address - Fax:217-351-1740
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038004290111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1015000OtherBLUE CROSS BLUE SHIELD
IL1015000OtherBLUE CROSS BLUE SHIELD