Healthcare Provider Details

I. General information

NPI: 1790062008
Provider Name (Legal Business Name): SAUER CHIROPRACTIC & SPORTS CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2011
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 N MAIN ST
ELLINWOOD KS
67526-1638
US

IV. Provider business mailing address

6 N MAIN ST
ELLINWOOD KS
67526-1638
US

V. Phone/Fax

Practice location:
  • Phone: 620-564-2555
  • Fax: 620-564-2711
Mailing address:
  • Phone: 620-564-2555
  • Fax: 620-564-2711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number0104026
License Number StateKS

VIII. Authorized Official

Name: AARON SAUER
Title or Position: OWNER
Credential: D.C., C.C.S.P.
Phone: 620-564-2555