Provider Demographics
NPI:1356545859
Name:SAGER, KEVIN D (DC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:D
Last Name:SAGER
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 1:102 S CHRISTY AVE
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:IL
Mailing Address - Zip Code:62466-1027
Mailing Address - Country:US
Mailing Address - Phone:618-936-3100
Mailing Address - Fax:
Practice Address - Street 1:102 S CHRISTY AVE
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:IL
Practice Address - Zip Code:62466-1027
Practice Address - Country:US
Practice Address - Phone:618-936-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0005122038OtherBLUE CROSS BLUE SHIELD
IL0005122038OtherBLUE CROSS BLUE SHIELD