Provider Demographics
NPI:1326014515
Name:SANDERS, MARK BAKER (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:BAKER
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 1:2402 TORO CANYON RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-2419
Mailing Address - Country:US
Mailing Address - Phone:512-327-6420
Mailing Address - Fax:
Practice Address - Street 1:609 CASTLE RIDGE RD
Practice Address - Street 2:SUITE 330
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5147
Practice Address - Country:US
Practice Address - Phone:512-347-8033
Practice Address - Fax:512-328-5114
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2383111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T15724Medicare UPIN
TX600722Medicare ID - Type Unspecified