Healthcare Provider Details

I. General information

NPI: 1215131149
Provider Name (Legal Business Name): SANDRA K CUNNINGHAM, DC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 MIDDLETOWN RD.
WHITE HALL WV
26554-8106
US

IV. Provider business mailing address

158 MIDDLETOWN RD.
WHITE HALL WV
26554-8106
US

V. Phone/Fax

Practice location:
  • Phone: 304-363-4343
  • Fax: 304-367-9802
Mailing address:
  • Phone: 304-363-4343
  • Fax: 304-367-9802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number739
License Number StateWV

VIII. Authorized Official

Name: MS. MONICA LYNN THOMPSON
Title or Position: BILLING COORDINATOR
Credential:
Phone: 304-363-4343