Provider Demographics
NPI:1053379628
Name:MCCARLIE, SARA (DC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:MCCARLIE
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 1:3294 ROYAL DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-8534
Mailing Address - Country:US
Mailing Address - Phone:530-672-1790
Mailing Address - Fax:
Practice Address - Street 1:3294 ROYAL DR
Practice Address - Street 2:SUITE 104
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-8534
Practice Address - Country:US
Practice Address - Phone:530-672-1790
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0269000Medicare ID - Type UnspecifiedCHIROPRACTOR