Healthcare Provider Details

I. General information

NPI: 1235248436
Provider Name (Legal Business Name): SANDRA K CUNNINGHAM D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/25/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 E STATE ROAD 32
WESTFIELD IN
46074-8767
US

IV. Provider business mailing address

514 E SR 32
WESTFIELD IN
46074-9632
US

V. Phone/Fax

Practice location:
  • Phone: 317-575-9310
  • Fax: 317-399-7433
Mailing address:
  • Phone: 317-575-9310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001094A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001094
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: