Provider Demographics
NPI:1114137361
Name:SANICKI, MATTHEW JONATHAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JONATHAN
Last Name:SANICKI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2902 POINSETTIA DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-1128
Mailing Address - Country:US
Mailing Address - Phone:619-501-1673
Mailing Address - Fax:619-299-2212
Practice Address - Street 1:2751 ROOSEVELT RD
Practice Address - Street 2:BUILDING 210, SUITE 203
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-6180
Practice Address - Country:US
Practice Address - Phone:619-795-2224
Practice Address - Fax:619-793-5517
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28735111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor