Provider Demographics
NPI:1851917157
Name:MONTESA, SARAH L (DC, LAC, DIPL AC)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:L
Last Name:MONTESA
Suffix:
Gender:F
Credentials:DC, LAC, DIPL AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 W HARRISON RD
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-3215
Mailing Address - Country:US
Mailing Address - Phone:224-488-0939
Mailing Address - Fax:
Practice Address - Street 1:1323 BUTTERFIELD RD STE 108
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-5620
Practice Address - Country:US
Practice Address - Phone:847-815-1434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013594111N00000X
IL198.001532171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist