Provider Demographics
NPI:1194531152
Name:FRIEDT, SAGE MATTEA (DC)
Entity type:Individual
Prefix:
First Name:SAGE
Middle Name:MATTEA
Last Name:FRIEDT
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 1:2710 E LINCOLN ST STE A
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-6010
Mailing Address - Country:US
Mailing Address - Phone:309-662-8418
Mailing Address - Fax:309-662-8197
Practice Address - Street 1:2710 E LINCOLN ST STE A
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-6010
Practice Address - Country:US
Practice Address - Phone:309-662-8418
Practice Address - Fax:309-662-8197
Is Sole Proprietor?:No
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038014211111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor