Provider Demographics
NPI:1215311931
Name:PERRY, SARA (DC)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:PERRY
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 1:15644 MADISON AVE
Mailing Address - Street 2:STE 213
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-5622
Mailing Address - Country:US
Mailing Address - Phone:216-801-4322
Mailing Address - Fax:330-319-8842
Practice Address - Street 1:15644 MADISON AVE
Practice Address - Street 2:STE 213
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-5622
Practice Address - Country:US
Practice Address - Phone:216-801-4322
Practice Address - Fax:330-319-8842
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015020487111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA2711Medicare UPIN