Provider Demographics
NPI:1508051806
Name:MARK, SANFORD LAWRENCE (DC)
Entity Type:Individual
Prefix:DR
First Name:SANFORD
Middle Name:LAWRENCE
Last Name:MARK
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 1:1417 LITCHEM RD
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-3068
Mailing Address - Country:US
Mailing Address - Phone:407-802-7731
Mailing Address - Fax:
Practice Address - Street 1:764 S TAMPA AVE UNIT D
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-3600
Practice Address - Country:US
Practice Address - Phone:407-839-1700
Practice Address - Fax:407-839-1209
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9365111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor