Provider Demographics
NPI:1578929345
Name:MCGOURTY, SANDRA NICOLE (DC)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:NICOLE
Last Name:MCGOURTY
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 1:14130 NOBLEWOOD PLZ STE 204
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-1466
Mailing Address - Country:US
Mailing Address - Phone:703-878-3434
Mailing Address - Fax:703-878-3833
Practice Address - Street 1:14130 NOBLEWOOD PLZ STE 204
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-1466
Practice Address - Country:US
Practice Address - Phone:703-878-3434
Practice Address - Fax:703-878-3833
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557275111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor