Provider Demographics
NPI:1679864326
Name:STROUD, SARA BETH (DC)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:BETH
Last Name:STROUD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:BETH
Other - Last Name:HEATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 12559
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-2559
Mailing Address - Country:US
Mailing Address - Phone:910-238-2330
Mailing Address - Fax:910-238-2320
Practice Address - Street 1:445 WESTERN BLVD
Practice Address - Street 2:SUITE O
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6845
Practice Address - Country:US
Practice Address - Phone:910-238-2330
Practice Address - Fax:910-238-2320
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4166111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5919473Medicaid