Provider Demographics
NPI:1912368697
Name:MINNICK, SARA BETH (DC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:BETH
Last Name:MINNICK
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 1:705 W HIGHWAY 50
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1900
Mailing Address - Country:US
Mailing Address - Phone:618-624-4242
Mailing Address - Fax:618-624-4248
Practice Address - Street 1:705 W HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1900
Practice Address - Country:US
Practice Address - Phone:618-624-4242
Practice Address - Fax:618-624-4248
Is Sole Proprietor?:No
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012951111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor