Provider Demographics
NPI:1497109516
Name:DERENZO, SARAH LEE (DC)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:LEE
Last Name:DERENZO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:PENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21 TRIMOUNTAIN AVE
Mailing Address - Street 2:PO BOX 101
Mailing Address - City:SOUTH RANGE
Mailing Address - State:MI
Mailing Address - Zip Code:49963-0101
Mailing Address - Country:US
Mailing Address - Phone:906-553-1106
Mailing Address - Fax:
Practice Address - Street 1:21 TRIMOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH RANGE
Practice Address - State:MI
Practice Address - Zip Code:49963-0101
Practice Address - Country:US
Practice Address - Phone:906-553-1106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor