Provider Demographics
NPI:1235248436
Name:CUNNINGHAM, SANDRA K (DC)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:K
Last Name:CUNNINGHAM
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 1:514 E STATE ROAD 32
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8767
Mailing Address - Country:US
Mailing Address - Phone:317-575-9310
Mailing Address - Fax:317-399-7433
Practice Address - Street 1:514 E STATE ROAD 32
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-8767
Practice Address - Country:US
Practice Address - Phone:317-575-9310
Practice Address - Fax:317-399-7433
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001094A111N00000X
IN08001094111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200157960Medicaid
260950Medicare Oscar/Certification
IN200157960Medicaid
IN200157960Medicaid