Provider Demographics
NPI:1477026292
Name:SANDOVAL, CARLOS (DC)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:SANDOVAL
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 1:1117 HARRISON RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-3290
Mailing Address - Country:US
Mailing Address - Phone:505-603-4467
Mailing Address - Fax:
Practice Address - Street 1:2860 CERRILLOS RD STE C2
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-2326
Practice Address - Country:US
Practice Address - Phone:505-772-0114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDC2195111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor