Provider Demographics
NPI:1538177597
Name:CAMPIONE, SAGE LM (DC)
Entity type:Individual
Prefix:DR
First Name:SAGE
Middle Name:LM
Last Name:CAMPIONE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 COUNTRY CLUB DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAINT SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522
Mailing Address - Country:US
Mailing Address - Phone:813-416-7714
Mailing Address - Fax:877-260-9213
Practice Address - Street 1:282 REDFERN VILLAGE
Practice Address - Street 2:
Practice Address - City:SAINT SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522
Practice Address - Country:US
Practice Address - Phone:912-434-7044
Practice Address - Fax:877-260-9213
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8164111N00000X
WI4356-012111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U85417Medicare UPIN
FL70211CMedicare ID - Type Unspecified