Provider Demographics
NPI:1154468155
Name:SANDRIK, BRIAN SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:SCOTT
Last Name:SANDRIK
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 1:1034 W ARROW HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-2486
Mailing Address - Country:US
Mailing Address - Phone:909-592-4444
Mailing Address - Fax:909-599-6445
Practice Address - Street 1:1034 W ARROW HWY
Practice Address - Street 2:SUITE C
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2486
Practice Address - Country:US
Practice Address - Phone:909-592-4444
Practice Address - Fax:909-599-6445
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 19593111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU30333Medicare UPIN
CADC 19593Medicare ID - Type UnspecifiedLICENSE