Provider Demographics
NPI:1093749186
Name:SANFORD, RICHARD M (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:SANFORD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 HWY 35
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5920
Mailing Address - Country:US
Mailing Address - Phone:732-530-3200
Mailing Address - Fax:732-530-3277
Practice Address - Street 1:262 HWY 35
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5920
Practice Address - Country:US
Practice Address - Phone:732-530-3200
Practice Address - Fax:732-530-3277
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2587111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ094562Medicare UPIN
NJ094562Medicare ID - Type Unspecified