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General NPI Number Information
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NPI Number | 1982887170
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Entity Type | Organization
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Legal Business Name | SAGE HOLISTIC HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 04/25/2012
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Provider Practice Location Address
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Address Line | 4560 STATE ROUTE 229
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City | MARENGO
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State | OH
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Zip | 43334-0253
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Country | US
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Telephone | 419-253-1234
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Fax | 419-253-1334
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Provider Business Mailing Address
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Address Line | PO BOX 253
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City | MARENGO
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State | OH
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Zip | 43334-0253
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Country | US
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Telephone | 419-253-1234
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Fax | 419-253-1334
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | MR. MARK ZACHARY ZADER
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Credential | DC
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Telephone | 419-253-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3147
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License Number State | OH
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