Provider Demographics
NPI:1154714962
Name:WATERKAMP, SARAH (DC)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:
Last Name:WATERKAMP
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 1:10451 MARY BELL AVE
Mailing Address - Street 2:
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91040-1503
Mailing Address - Country:US
Mailing Address - Phone:818-231-7672
Mailing Address - Fax:818-951-7352
Practice Address - Street 1:1431 WARNER AVE
Practice Address - Street 2:STE D
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6444
Practice Address - Country:US
Practice Address - Phone:714-258-7116
Practice Address - Fax:714-258-7484
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33199111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor