Provider Demographics
NPI:1518155449
Name:SANDIFER, SCOTT GREGORY (DC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:GREGORY
Last Name:SANDIFER
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 1:2204 N ROAD 48
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-2311
Mailing Address - Country:US
Mailing Address - Phone:509-547-9442
Mailing Address - Fax:509-545-8108
Practice Address - Street 1:805 GOETHALS DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3534
Practice Address - Country:US
Practice Address - Phone:509-547-9442
Practice Address - Fax:509-545-8108
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003223111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB00854Medicare PIN