Healthcare Provider Details

I. General information

NPI: 1578706875
Provider Name (Legal Business Name): SANDRA K. CUNNINGHAM DC,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2009
Last Update Date: 04/14/2017
Certification Date:
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 STATE ROAD 32
WESTFIELD IN
46074-8767
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number08001094
License Number StateIN

VIII. Authorized Official

Name: DR. SANDRA K CUNNINGHAM
Title or Position: DOCTOR / OWNER
Credential: D.C
Phone: 317-575-9310