Provider Demographics
NPI:1356472815
Name:SAZDANOFF, TED L (DC)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:L
Last Name:SAZDANOFF
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 1:990 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-2246
Mailing Address - Country:US
Mailing Address - Phone:419-756-6111
Mailing Address - Fax:419-756-2549
Practice Address - Street 1:990 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-2246
Practice Address - Country:US
Practice Address - Phone:419-756-6111
Practice Address - Fax:419-756-2549
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH980111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2765217Medicaid
OH341444686OtherTAX IDENTIFICATION
OH0526333Medicare PIN
OH341444686OtherTAX IDENTIFICATION