Provider Demographics
NPI:1225322332
Name:MOORE, SARAH A (DC)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:A
Last Name:MOORE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:A
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 W ROYAL LEE DR
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:WI
Mailing Address - Zip Code:53156-9209
Mailing Address - Country:US
Mailing Address - Phone:262-495-6525
Mailing Address - Fax:
Practice Address - Street 1:1200 W ROYAL LEE DR
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:WI
Practice Address - Zip Code:53156
Practice Address - Country:US
Practice Address - Phone:262-495-6525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC4204111N00000X
IL038.011940111N00000X
WI4800-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor