Provider Demographics
NPI:1003547548
Name:SANDERS, REGINA RENEE (DC)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:RENEE
Last Name:SANDERS
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 1:4 SPRING VISTA CT
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN INN
Mailing Address - State:SC
Mailing Address - Zip Code:29644-3418
Mailing Address - Country:US
Mailing Address - Phone:864-378-2394
Mailing Address - Fax:
Practice Address - Street 1:201 MCCULLOUGH DR STE 350
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-1368
Practice Address - Country:US
Practice Address - Phone:704-817-8185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4683111N00000X
NC5397111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor