Provider Demographics
NPI:1285854935
Name:SANDERS, CHARLES PHILIP (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:PHILIP
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 1:3636 4TH AVE
Mailing Address - Street 2:#200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4280
Mailing Address - Country:US
Mailing Address - Phone:619-296-4994
Mailing Address - Fax:619-296-4995
Practice Address - Street 1:3636 4TH AVE
Practice Address - Street 2:#200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4280
Practice Address - Country:US
Practice Address - Phone:619-296-4994
Practice Address - Fax:619-296-4995
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor