Healthcare Provider Details

I. General information

NPI: 1669751723
Provider Name (Legal Business Name): SARA DONOVAN ALEXANDER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA MARIE DONOVAN DC

II. Dates (important events)

Enumeration Date: 08/08/2011
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 S KANNER HWY
STUART FL
34994-7204
US

IV. Provider business mailing address

1290 NW LAKESIDE TRL
STUART FL
34994-9509
US

V. Phone/Fax

Practice location:
  • Phone: 772-286-6260
  • Fax: 772-286-6912
Mailing address:
  • Phone: 772-530-4028
  • Fax: 772-232-6068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH10221
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: