Active NPI
Petra Alexandra Sullwold, DC
- Chiropractor
- Mancos, CO
National Provider Identifier
1063661031
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 31018
- Practice address
- 245 N Main St
Mancos, CO 81328-9092 - Phone
- (970) 903-8901
- NPI assigned
- Sep 15, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 31018 | CA | Primary |
Addresses
Primary practice location
245 N Main St
Mancos, CO 81328-9092
Mailing address
PO Box 536
Mancos, CO 81328-0536
Phone (970) 903-8901
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31018 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1221436800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605571200000",
"number": "1063661031",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 536",
"city": "MANCOS",
"state": "CO",
"postal_code": "813280536",
"telephone_number": "970-903-8901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "245 N MAIN ST",
"city": "MANCOS",
"state": "CO",
"postal_code": "813289092",
"telephone_number": "970-903-8901"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLWOLD",
"first_name": "PETRA",
"middle_name": "ALEXANDRA",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-09-15",
"last_updated": "2020-11-17",
"certification_date": "2020-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "31018",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mancos, CO
- Polly Sikora, MA, LPC
- Mary Simpson, COTA
- Stephanie Smith, LCSW, LAC
- Southwest Health System, Inc.
- Laura Lee Spencer-Wagner, R.D.H.
- Gloria Lee Thatch-Woody, OTR
- The Valley Rehabilitation and Healthcare Center LLC
- The Valley Rehabilitation and Healthcare Center LLC
- Terri Townsend, PTA
- Vanessa Velasquez
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.