Provider Demographics
NPI:1891984456
Name:MANCUSO, SARA MICHELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:MICHELLE
Last Name:MANCUSO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8660 E RAINTREE DR SUITE 135
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260
Mailing Address - Country:US
Mailing Address - Phone:480-991-9945
Mailing Address - Fax:480-948-3204
Practice Address - Street 1:8360 E RAINTREE DR STE 135
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2687
Practice Address - Country:US
Practice Address - Phone:480-991-9945
Practice Address - Fax:480-948-3204
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7871111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor