Provider Demographics
NPI:1265658249
Name:SANDERS, ERIC D (DC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:D
Last Name:SANDERS
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 1:323 N AGASSIZ ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-4604
Mailing Address - Country:US
Mailing Address - Phone:928-213-1437
Mailing Address - Fax:
Practice Address - Street 1:323 N AGASSIZ ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4604
Practice Address - Country:US
Practice Address - Phone:928-213-1437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5563111N00000X
UT952947271202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor