Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 4155 | OH |
N | 111N00000X | Chiropractor | 884 | NH |
Y | 111NP0017X | Pediatric Chiropractor | 5555 | OR |
N | 111NP0017X | Pediatric Chiropractor | 884 | NH |
NPI | 1972809770 |
---|---|
Provider Name | Dr. Satya S Sardonicus |
First Address | Portland, OR 97221-2754 |
Second Address | Portland, OR 97221-2754 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2011 |
Last Update Date | 09/08/2015 |