Provider Demographics
NPI:1972809770
Name:SARDONICUS, SATYA S (DC)
Entity type:Individual
Prefix:DR
First Name:SATYA
Middle Name:S
Last Name:SARDONICUS
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 1:601 SW ARBORETUM CIR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-2754
Mailing Address - Country:US
Mailing Address - Phone:503-395-4517
Mailing Address - Fax:
Practice Address - Street 1:601 SW ARBORETUM CIR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-2754
Practice Address - Country:US
Practice Address - Phone:503-395-4517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2015-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4155111N00000X
NH884111NP0017X, 111N00000X
OR5555111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No111N00000XChiropractic ProvidersChiropractor