Provider Demographics
NPI:1962418996
Name:KILEY, SARAH ANN (DC)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:ANN
Last Name:KILEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2850 ARTESIA BLVD
Mailing Address - Street 2:STE 207
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3419
Mailing Address - Country:US
Mailing Address - Phone:310-371-4774
Mailing Address - Fax:310-371-3453
Practice Address - Street 1:2850 ARTESIA BLVD
Practice Address - Street 2:STE 207
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3419
Practice Address - Country:US
Practice Address - Phone:310-371-4774
Practice Address - Fax:310-371-3453
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25457111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U72112Medicare UPIN
CADC25457Medicare PIN