Healthcare Provider Details

I. General information

NPI: 1649637182
Provider Name (Legal Business Name): SALLY DAO D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 S RANGELINE RD STE. R
CARMEL IN
46032-2148
US

IV. Provider business mailing address

622 S RANGELINE RD STE. R
CARMEL IN
46032-2148
US

V. Phone/Fax

Practice location:
  • Phone: 317-575-1115
  • Fax: 317-663-0828
Mailing address:
  • Phone: 317-575-1115
  • Fax: 317-663-0828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002883A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: