Provider Demographics
NPI:1104834480
Name:SANDERSON, DEBORAH MAYHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:MAYHEW
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:DEBORAH
Other - Middle Name:LOU
Other - Last Name:MAYHEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1550 INSURANCE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-7229
Mailing Address - Country:US
Mailing Address - Phone:434-296-8100
Mailing Address - Fax:434-975-1023
Practice Address - Street 1:1550 INSURANCE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-7229
Practice Address - Country:US
Practice Address - Phone:434-296-8100
Practice Address - Fax:434-975-1023
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556193111N00000X
FLCH7477111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA242876OtherSOUTHER HEALTH PIN NUMBER
VA71965538OtherAETNA PIN NUMBER
VA103382OtherBC/BS PIN NUMBER
VA2219233OtherCIGNA'S PIN NUMBER
VA1900009640Medicare ID - Type Unspecified
VA242876OtherSOUTHER HEALTH PIN NUMBER
VA2219233OtherCIGNA'S PIN NUMBER