Provider Demographics
NPI:1386770253
Name:AGER, SANDRA M (DC)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:M
Last Name:AGER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SANDRA
Other - Middle Name:M
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1127 HERITAGE CT
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-3063
Mailing Address - Country:US
Mailing Address - Phone:608-279-0405
Mailing Address - Fax:
Practice Address - Street 1:948 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-2039
Practice Address - Country:US
Practice Address - Phone:608-318-1786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4289-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38974900Medicaid
WI38974900Medicaid
WI000235901Medicare PIN