Provider Demographics
NPI:1093490211
Name:MULLIGAN, SARAH (LAC, DACHM, MSOM)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MULLIGAN
Suffix:
Gender:F
Credentials:LAC, DACHM, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1549 E 497TH RD
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-7404
Mailing Address - Country:US
Mailing Address - Phone:417-599-1152
Mailing Address - Fax:
Practice Address - Street 1:1801 W NORTON RD STE 202
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-5367
Practice Address - Country:US
Practice Address - Phone:417-599-1152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023022982171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist