Provider Demographics
NPI:1790907525
Name:SHARP, RAE HUNT (DC, QME)
Entity Type:Individual
Prefix:DR
First Name:RAE
Middle Name:HUNT
Last Name:SHARP
Suffix:
Gender:F
Credentials:DC, QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 N E ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405-2615
Mailing Address - Country:US
Mailing Address - Phone:909-881-1978
Mailing Address - Fax:909-882-7525
Practice Address - Street 1:3155 N E ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92405-2615
Practice Address - Country:US
Practice Address - Phone:909-881-1978
Practice Address - Fax:909-882-7525
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17713111N00000X, 111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0177130Medicare ID - Type Unspecified
CAT0643Medicare UPIN