MEDICARE: AGER CHIROPRACTIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4289-12	WI

General Provider Information

NPI Number	:	1477815918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGER CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	948 W MAIN ST
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-2039
Country	:	US
Telephone Number	:	608-279-0405
Fax Number	:

Provider Business Practice Location Address
First Line	:	948 W MAIN ST
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-2039
Country	:	US
Telephone Number	:	608-279-0405
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	DR. SANDRA M AGER
Credential	:	D.C.
Telephone Number	:	608-279-0405

Provider Enumeration Date	:	06/11/2012
Last Update Date	:	06/13/2012

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