Provider Demographics
NPI:1841200300
Name:PACWA, SANDRA YVONNE (DC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:YVONNE
Last Name:PACWA
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 1:1531 HUNT CLUB BLVD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-6095
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1531 HUNT CLUB BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-6095
Practice Address - Country:US
Practice Address - Phone:931-338-2077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1524111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU94143Medicare UPIN
TN3973944Medicare PIN