Provider Demographics
NPI:1033147624
Name:MCCUISTON, SANDRA (DC)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:MCCUISTON
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 1:2128 HILLSDALE
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-1236
Mailing Address - Country:US
Mailing Address - Phone:248-608-0993
Mailing Address - Fax:586-566-5250
Practice Address - Street 1:46755 HAYES RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-5507
Practice Address - Country:US
Practice Address - Phone:586-532-5433
Practice Address - Fax:586-566-5250
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007921111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MISM007921OtherBLUE CROSS
MIN66780001Medicare ID - Type Unspecified