Provider Demographics
NPI:1366560666
Name:SARAH KEUSS, P.C.
Entity type:Organization
Organization Name:SARAH KEUSS, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ALEENE
Authorized Official - Last Name:KEUSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-282-4529
Mailing Address - Street 1:6818 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4645
Mailing Address - Country:US
Mailing Address - Phone:773-282-4529
Mailing Address - Fax:
Practice Address - Street 1:6818 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4645
Practice Address - Country:US
Practice Address - Phone:773-282-4529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1635345OtherBCBSPROVIDER
IL211955Medicare ID - Type UnspecifiedMEDICARE PROVIDER