Provider Demographics
NPI:1578745964
Name:SUTHERLIN CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:SUTHERLIN CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:SARNOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-459-2583
Mailing Address - Street 1:PO BOX 600
Mailing Address - Street 2:
Mailing Address - City:SUTHERLIN
Mailing Address - State:OR
Mailing Address - Zip Code:97479-0600
Mailing Address - Country:US
Mailing Address - Phone:541-459-2583
Mailing Address - Fax:541-459-9238
Practice Address - Street 1:219 N UMPQUA ST
Practice Address - Street 2:
Practice Address - City:SUTHERLIN
Practice Address - State:OR
Practice Address - Zip Code:97479-9568
Practice Address - Country:US
Practice Address - Phone:541-459-2583
Practice Address - Fax:541-459-9238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3457111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR119161Medicare PIN