Provider Demographics
NPI:1912902065
Name:CUNNINGHAM, SANDRA K (DC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:K
Last Name:CUNNINGHAM
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 1:158 MIDDLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:WV
Mailing Address - Zip Code:26554-8106
Mailing Address - Country:US
Mailing Address - Phone:304-363-4343
Mailing Address - Fax:304-367-9802
Practice Address - Street 1:158 MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:WV
Practice Address - Zip Code:26554-8104
Practice Address - Country:US
Practice Address - Phone:304-363-4343
Practice Address - Fax:304-367-9802
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV739111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2202018000Medicaid
WVU95456Medicare UPIN
WV4048081Medicare ID - Type Unspecified