Provider Demographics
NPI:1467640839
Name:RONALD B. SANDERS A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:RONALD B. SANDERS A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:B
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PC
Authorized Official - Phone:435-381-5432
Mailing Address - Street 1:P.O. BOX 495
Mailing Address - Street 2:46 E MAIN ST
Mailing Address - City:CASTLE DALE
Mailing Address - State:UT
Mailing Address - Zip Code:84513-0495
Mailing Address - Country:US
Mailing Address - Phone:435-381-5432
Mailing Address - Fax:435-381-5630
Practice Address - Street 1:46 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CASTLE DALE
Practice Address - State:UT
Practice Address - Zip Code:84513-0495
Practice Address - Country:US
Practice Address - Phone:435-381-5432
Practice Address - Fax:435-381-5630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT160327-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000057497Medicare PIN