Healthcare Provider Details

I. General information

NPI: 1417088410
Provider Name (Legal Business Name): KIRSTEN SAGE CHIROPRACTIC PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 ENCINITAS BLVD SUITE 100
ENCINITAS CA
92024-3741
US

IV. Provider business mailing address

531 ENCINITAS BLVD SUITE 100
ENCINITAS CA
92024-3741
US

V. Phone/Fax

Practice location:
  • Phone: 760-753-2157
  • Fax: 760-753-8108
Mailing address:
  • Phone: 760-753-2157
  • Fax: 760-753-8108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number27-1962
License Number StateCA

VIII. Authorized Official

Name: DR. KIRSTEN MICHELLE SAGE
Title or Position: PRESIDENT
Credential: D.C.
Phone: 760-753-2157