Provider Demographics
NPI:1437115714
Name:AMUNDSEN, SANDRA ANN (D C)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:ANN
Last Name:AMUNDSEN
Suffix:
Gender:F
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-3727
Mailing Address - Country:US
Mailing Address - Phone:517-324-3807
Mailing Address - Fax:517-324-3820
Practice Address - Street 1:1729 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-3727
Practice Address - Country:US
Practice Address - Phone:517-324-3807
Practice Address - Fax:517-324-3820
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005059111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1641065Medicaid
MI950C35002OtherBLUE CROSS AND BLUE SHIEL
MI44-09226OtherPHYSICIANS HEALTH PLAN
MI44-09226OtherPHYSICIANS HEALTH PLAN