Provider Demographics
NPI:1124594791
Name:SANDERS, PERCELL J III (DC)
Entity Type:Individual
Prefix:
First Name:PERCELL
Middle Name:J
Last Name:SANDERS
Suffix:III
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 1:3021 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32206-2122
Mailing Address - Country:US
Mailing Address - Phone:904-350-5544
Mailing Address - Fax:904-350-9944
Practice Address - Street 1:3021 N MAIN ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-2122
Practice Address - Country:US
Practice Address - Phone:904-350-5544
Practice Address - Fax:904-350-9944
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12620111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH12620OtherMEDICAL LICENSE