MEDICARE: SANDRA G LEVY DC 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	006343	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1699711739	OTHER	MO	PROVIDER ID

General Provider Information

NPI Number	:	1548417850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDRA G LEVY DC LLC

Provider Business Mailing Address
First Line	:	608 N MCKNIGHT RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-4911
Country	:	US
Telephone Number	:	314-991-5655
Fax Number	:	314-991-4872

Provider Business Practice Location Address
First Line	:	608 N MCKNIGHT RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-4911
Country	:	US
Telephone Number	:	314-991-5655
Fax Number	:	314-991-4872

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SANDRA G LEVY
Credential	:	DC
Telephone Number	:	314-991-5655

Provider Enumeration Date	:	08/19/2008
Last Update Date	:	08/19/2008

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