Provider Demographics
NPI:1013222835
Name:SANDERS, KRISTINE E (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:E
Last Name:SANDERS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:K.
Other - Middle Name:ERICA
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:5115 EXCELSIOR BLVD
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2906
Mailing Address - Country:US
Mailing Address - Phone:651-431-1962
Mailing Address - Fax:
Practice Address - Street 1:1497 WHITE BEAR AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-2414
Practice Address - Country:US
Practice Address - Phone:651-705-6701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5265111N00000X, 111NN1001X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NR0400XChiropractic ProvidersChiropractorRehabilitation