Provider Demographics
NPI:1629349485
Name:POTTHOFF, SARAH ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:ANN
Last Name:POTTHOFF
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 1:18183 220TH ST
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-9040
Mailing Address - Country:US
Mailing Address - Phone:712-790-1657
Mailing Address - Fax:
Practice Address - Street 1:715 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-2534
Practice Address - Country:US
Practice Address - Phone:712-790-1657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007510111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor