Provider Demographics
NPI:1255478665
Name:DR. RICHARD SAND, D.C., P.A
Entity Type:Organization
Organization Name:DR. RICHARD SAND, D.C., P.A
Other - Org Name:VALLEY WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:SAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PA
Authorized Official - Phone:763-377-6655
Mailing Address - Street 1:1710 DOUGLAS DR N
Mailing Address - Street 2:SUITE 220
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4327
Mailing Address - Country:US
Mailing Address - Phone:763-377-6655
Mailing Address - Fax:763-377-1666
Practice Address - Street 1:1710 DOUGLAS DR N
Practice Address - Street 2:SUITE 220
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4327
Practice Address - Country:US
Practice Address - Phone:763-377-6655
Practice Address - Fax:763-377-1666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMINNESOTA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN198027100Medicaid
MN198027100Medicaid