Provider Demographics
NPI:1164473013
Name:SANFORD, TIMOTHY CLAIR (DC)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:CLAIR
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 1:5521 W CINNABAR AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-2107
Mailing Address - Country:US
Mailing Address - Phone:623-444-9339
Mailing Address - Fax:
Practice Address - Street 1:2830 W NORTHERN AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-6626
Practice Address - Country:US
Practice Address - Phone:602-995-3755
Practice Address - Fax:602-995-3759
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7692111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor