Provider Demographics
NPI:1073564076
Name:CROTEAU, SARA CHRISTINE (DC)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:CHRISTINE
Last Name:CROTEAU
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16611 NE RUSSELL ST
Mailing Address - Street 2:APT 76
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-5900
Mailing Address - Country:US
Mailing Address - Phone:503-841-2601
Mailing Address - Fax:
Practice Address - Street 1:9520 SW BEAVERTON HILLSDALE HWY
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3309
Practice Address - Country:US
Practice Address - Phone:971-227-6409
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR713644111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor