Healthcare Provider Details

I. General information

NPI: 1811179070
Provider Name (Legal Business Name): DR KRISTINA L SARGENT, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 11/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 E ROOSEVELT RD SUITE 107
WHEATON IL
60187-5589
US

IV. Provider business mailing address

416 E ROOSEVELT RD SUITE 107
WHEATON IL
60187-5589
US

V. Phone/Fax

Practice location:
  • Phone: 630-682-5090
  • Fax: 630-260-1230
Mailing address:
  • Phone: 630-682-5090
  • Fax: 630-260-1230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number038007040
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number038007040
License Number StateIL

VIII. Authorized Official

Name: DR. KRISTINA L SARGENT
Title or Position: OWNER / COE
Credential: D.C.
Phone: 630-682-5090