Provider Demographics
NPI:1508932765
Name:COE, SANFORD M (DC)
Entity Type:Individual
Prefix:DR
First Name:SANFORD
Middle Name:M
Last Name:COE
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 1:8127 CULEBRA RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-1634
Mailing Address - Country:US
Mailing Address - Phone:210-684-2313
Mailing Address - Fax:
Practice Address - Street 1:8127 CULEBRA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-1634
Practice Address - Country:US
Practice Address - Phone:210-684-2313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5398111N00000X
TX98494111N00000X
NM1990111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU96778Medicare UPIN
509528Medicare ID - Type Unspecified