Provider Demographics
NPI:1447234745
Name:STANTON, SANDRA MARIE (DC)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:MARIE
Last Name:STANTON
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:PO BOX 803
Mailing Address - Street 2:
Mailing Address - City:PINCONNING
Mailing Address - State:MI
Mailing Address - Zip Code:48650-0803
Mailing Address - Country:US
Mailing Address - Phone:616-863-9482
Mailing Address - Fax:616-863-9486
Practice Address - Street 1:500 NORTHLAND DR NE
Practice Address - Street 2:STE 200
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-7634
Practice Address - Country:US
Practice Address - Phone:616-863-9482
Practice Address - Fax:616-863-9482
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005877111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00099912OtherMEDICARE RAIL ROAD
MI03995OtherPRIORITY HEALTH
MIP00099912OtherMEDICARE RAIL ROAD
MIU62590Medicare UPIN