Provider Demographics
NPI:1023262953
Name:SAGE CHIROPRACTIC INCORPORATED
Entity type:Organization
Organization Name:SAGE CHIROPRACTIC INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUSSIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-799-0223
Mailing Address - Street 1:784 US HIGHWAY 1
Mailing Address - Street 2:SUITE 12
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-4415
Mailing Address - Country:US
Mailing Address - Phone:561-799-0223
Mailing Address - Fax:561-799-0263
Practice Address - Street 1:784 US HIGHWAY 1
Practice Address - Street 2:SUITE 12
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-4415
Practice Address - Country:US
Practice Address - Phone:561-799-0223
Practice Address - Fax:561-799-0263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5093261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty