Provider Demographics
NPI:1215131149
Name:SANDRA K CUNNINGHAM, DC
Entity type:Organization
Organization Name:SANDRA K CUNNINGHAM, DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-363-4343
Mailing Address - Street 1:158 MIDDLETOWN RD.
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:WV
Mailing Address - Zip Code:26554-8106
Mailing Address - Country:US
Mailing Address - Phone:304-363-4343
Mailing Address - Fax:304-367-9802
Practice Address - Street 1:158 MIDDLETOWN RD.
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:WV
Practice Address - Zip Code:26554-8106
Practice Address - Country:US
Practice Address - Phone:304-363-4343
Practice Address - Fax:304-367-9802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV739111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2202018000Medicaid
WVU95456Medicare UPIN
WV4048081Medicare ID - Type Unspecified