Provider Demographics
NPI:1912998733
Name:SUMNER HEALTH CLINIC, LTD.
Entity Type:Organization
Organization Name:SUMNER HEALTH CLINIC, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SAGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-936-3100
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:618-936-3170
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:618-936-3170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212297Medicare ID - Type Unspecified