Provider Demographics
NPI:1730244781
Name:SASSER, DENVER GKS (DC)
Entity type:Individual
Prefix:DR
First Name:DENVER
Middle Name:GKS
Last Name:SASSER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1498 E OAK RD
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-3191
Mailing Address - Country:US
Mailing Address - Phone:480-341-7820
Mailing Address - Fax:
Practice Address - Street 1:8655 E VIA DE VENTURA STE E160
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3395
Practice Address - Country:US
Practice Address - Phone:480-596-1686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002221A111N00000X
AZ2192246ZE0600X
AZ8257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000386434OtherBLUE CROSS BLUE SHIELD
IN200529270Medicaid
IN222670CMedicare ID - Type Unspecified
IN200529270Medicaid