Provider Demographics
NPI:1174282438
Name:SANBORN, TIAH (DC)
Entity Type:Individual
Prefix:
First Name:TIAH
Middle Name:
Last Name:SANBORN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6530 N OCEAN BLVD APT 116
Mailing Address - Street 2:
Mailing Address - City:OCEAN RIDGE
Mailing Address - State:FL
Mailing Address - Zip Code:33435-5224
Mailing Address - Country:US
Mailing Address - Phone:561-891-0180
Mailing Address - Fax:
Practice Address - Street 1:1800 W WOOLBRIGHT RD STE 101
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-6398
Practice Address - Country:US
Practice Address - Phone:561-572-3542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13754111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor