Provider Demographics
NPI:1699711739
Name:LEVY, SANDRA G (DC)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:G
Last Name:LEVY
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 1:8229 CLAYTON RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1155
Mailing Address - Country:US
Mailing Address - Phone:314-991-5655
Mailing Address - Fax:314-932-5080
Practice Address - Street 1:8229 CLAYTON RD
Practice Address - Street 2:SUITE 204
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1155
Practice Address - Country:US
Practice Address - Phone:314-991-5655
Practice Address - Fax:314-932-5080
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO6343111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO324370001OtherMEDICARE PTAN
10292TOtherBLUE CROSS BLUE SHIELD
10292TOtherBOEING
431886446LEYOtherMERCY
279375OtherHEALTHLINK
5456227OtherAETNA
62493OtherGHP
7088OtherBLUE CHOICE
U55174Medicare UPIN