Provider Demographics
NPI:1831173731
Name:DENO, SARA LYNN DUPONT (DC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:LYNN DUPONT
Last Name:DENO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:DUPONT
Other - Last Name:LYNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:429 S 10TH ST STE 5
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-3315
Mailing Address - Country:US
Mailing Address - Phone:906-233-7487
Mailing Address - Fax:855-307-0173
Practice Address - Street 1:429 S 10TH ST STE 5
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-3315
Practice Address - Country:US
Practice Address - Phone:906-233-7487
Practice Address - Fax:855-307-0173
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4114-012111N00000X
MI2301008928111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI144824882Medicaid
MI144865956Medicaid
MI950E510210OtherBCBSM
MI144865956Medicaid
MI144824882Medicaid