Provider Demographics
NPI:1932201563
Name:SAGE, VICTOR ANTHONY JR (DC)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:ANTHONY
Last Name:SAGE
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 WINDING WAY
Mailing Address - Street 2:STE. 204
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-3820
Mailing Address - Country:US
Mailing Address - Phone:610-325-6037
Mailing Address - Fax:
Practice Address - Street 1:2002 SPROUL RD
Practice Address - Street 2:STE. 204
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3510
Practice Address - Country:US
Practice Address - Phone:610-325-6037
Practice Address - Fax:610-325-6039
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-009493111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAV10515Medicare UPIN
PASA-104438Medicare ID - Type Unspecified