Provider Demographics
NPI:1437393568
Name:SANFORD, DOUGLAS W (DC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:W
Last Name:SANFORD
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 1:2600 ELECTRONIC LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-1216
Mailing Address - Country:US
Mailing Address - Phone:972-438-6932
Mailing Address - Fax:214-902-3475
Practice Address - Street 1:2600 ELECTRONIC LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-1216
Practice Address - Country:US
Practice Address - Phone:972-438-6932
Practice Address - Fax:214-902-3475
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77598111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB102824Medicare Oscar/Certification