Provider Demographics
NPI:1316001225
Name:SANDERS, RONALD B (DCPC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:B
Last Name:SANDERS
Suffix:
Gender:M
Credentials:DCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 W. VALLEY VIEW COURT
Mailing Address - Street 2:
Mailing Address - City:CASTLE DALE
Mailing Address - State:UT
Mailing Address - Zip Code:84513-0495
Mailing Address - Country:US
Mailing Address - Phone:435-381-5432
Mailing Address - Fax:435-381-5630
Practice Address - Street 1:46 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:CASTLE DALE
Practice Address - State:UT
Practice Address - Zip Code:84513-0495
Practice Address - Country:US
Practice Address - Phone:435-381-5432
Practice Address - Fax:435-381-5630
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT160327-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor