Provider Demographics
NPI:1003971219
Name:SANDERS, MARY ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
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 1:9530 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:CASCADE
Mailing Address - State:CO
Mailing Address - Zip Code:80809-1524
Mailing Address - Country:US
Mailing Address - Phone:719-684-2503
Mailing Address - Fax:
Practice Address - Street 1:2812 W COLORADO AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-2470
Practice Address - Country:US
Practice Address - Phone:719-475-2455
Practice Address - Fax:719-475-2254
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3993111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COB65742Medicare UPIN
CO47833Medicare ID - Type Unspecified