Individual
DR. PETRA ALEXANDRA SULLWOLD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
245 N MAIN ST, MANCOS, CO 81328-9092
(970) 903-8901
Mailing address
PO BOX 536, MANCOS, CO 81328-0536
(970) 903-8901
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
31018
CA
Other
Enumeration date
09/15/2008
Last updated
11/17/2020
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