Provider Demographics
NPI:1427488733
Name:VIVONA, SARA (DC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:VIVONA
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 1:3011 WILLIAMSBURG DR
Mailing Address - Street 2:APT 6
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-9365
Mailing Address - Country:US
Mailing Address - Phone:607-651-8691
Mailing Address - Fax:
Practice Address - Street 1:143 HARTMAN RD
Practice Address - Street 2:SUITE 1
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-7220
Practice Address - Country:US
Practice Address - Phone:724-205-6260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010764111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor