Provider Demographics
NPI:1467772004
Name:PROSAK, SARAH ELIZABETH (DC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH
Last Name:PROSAK
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 1:19800 DETROIT RD STE 201A
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-1885
Mailing Address - Country:US
Mailing Address - Phone:216-285-4070
Mailing Address - Fax:216-201-8794
Practice Address - Street 1:19800 DETROIT RD STE 201A
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-1885
Practice Address - Country:US
Practice Address - Phone:216-285-4070
Practice Address - Fax:216-201-8794
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-06
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4163111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH$$$$$$$$$OtherTAX ID
OHH003560Medicare PIN