Provider Demographics
NPI:1841375078
Name:DEHART, SARA L (DC)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:L
Last Name:DEHART
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 1:1503 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-3021
Mailing Address - Country:US
Mailing Address - Phone:940-566-1660
Mailing Address - Fax:940-380-1461
Practice Address - Street 1:1503 N ELM ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-3021
Practice Address - Country:US
Practice Address - Phone:940-566-1660
Practice Address - Fax:940-380-1461
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6982111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCO6055625Medicaid
TX605562Medicare ID - Type Unspecified
TXU63444Medicare UPIN