Provider Demographics
NPI:1043356694
Name:SAND, DIANNE SHIRLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:SHIRLEY
Last Name:SAND
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 1:330 S C M ALLEN PKWY
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-6902
Mailing Address - Country:US
Mailing Address - Phone:512-353-2882
Mailing Address - Fax:512-353-0132
Practice Address - Street 1:330 S C M ALLEN PKWY
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-6902
Practice Address - Country:US
Practice Address - Phone:512-353-2882
Practice Address - Fax:512-353-0132
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111N00000X, 111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX601671Medicare ID - Type UnspecifiedID #