Provider Demographics
NPI:1235321373
Name:KAVANAGH, SARAH JEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:JEAN
Last Name:KAVANAGH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 MARSCHALL RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-2688
Mailing Address - Country:US
Mailing Address - Phone:952-445-9313
Mailing Address - Fax:952-445-9313
Practice Address - Street 1:500 MARSCHALL RD
Practice Address - Street 2:SUITE 130
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-2688
Practice Address - Country:US
Practice Address - Phone:952-445-9313
Practice Address - Fax:952-445-9313
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN4998111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor