Provider Demographics
NPI:1487689543
Name:SANDELL, DONALD WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:WILLIAM
Last Name:SANDELL
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 1:319 MAIN STREET
Mailing Address - Street 2:PO BOX 809
Mailing Address - City:PECATONICA
Mailing Address - State:IL
Mailing Address - Zip Code:61063-0809
Mailing Address - Country:US
Mailing Address - Phone:815-239-1101
Mailing Address - Fax:815-239-1113
Practice Address - Street 1:319 MAIN STREET
Practice Address - Street 2:
Practice Address - City:PECATONICA
Practice Address - State:IL
Practice Address - Zip Code:61063-0809
Practice Address - Country:US
Practice Address - Phone:815-239-1101
Practice Address - Fax:815-239-1113
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0308-005954111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10132021OtherBLUE CROSS BLUE SHIELD
T38783Medicare UPIN
ILK45807Medicare PIN