Provider Demographics
NPI:1831228303
Name:SACHS, KIMBERLY JOANNA (DC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JOANNA
Last Name:SACHS
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 1:3030 FRANK SCOTT PKWY W STE 1
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-5014
Mailing Address - Country:US
Mailing Address - Phone:618-236-3600
Mailing Address - Fax:618-233-6100
Practice Address - Street 1:3030 FRANK SCOTT PKWY W STE 1
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-5014
Practice Address - Country:US
Practice Address - Phone:618-236-3600
Practice Address - Fax:618-233-6100
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010905111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILPENDINGOtherBLUE CROSS BLUE SHIELD
ILPENDINGOtherBLUE CROSS BLUE SHIELD