Provider Demographics
NPI:1316217524
Name:BAIRD, SANDY MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:SANDY
Middle Name:MARIE
Last Name:BAIRD
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 1:3409 GRAND AVE
Mailing Address - Street 2:#5
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2013
Mailing Address - Country:US
Mailing Address - Phone:510-465-2342
Mailing Address - Fax:510-465-2342
Practice Address - Street 1:3409 GRAND AVE
Practice Address - Street 2:#5
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2013
Practice Address - Country:US
Practice Address - Phone:510-465-2342
Practice Address - Fax:510-465-2342
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32125111NS0005X
CACA32125111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician