Provider Demographics
NPI:1962060962
Name:QUALY, SARA (DC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:QUALY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:DELUNAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:737 WHISPERING FOREST DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-4481
Mailing Address - Country:US
Mailing Address - Phone:314-662-6678
Mailing Address - Fax:
Practice Address - Street 1:737 WHISPERING FOREST DR
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-4481
Practice Address - Country:US
Practice Address - Phone:314-662-6678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019018468204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM