Provider Demographics
NPI:1518434752
Name:SANDERS CHIROPRACTIC AND FITNESS, LLC
Entity Type:Organization
Organization Name:SANDERS CHIROPRACTIC AND FITNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PHD, CSCS
Authorized Official - Phone:440-600-7407
Mailing Address - Street 1:7209 CHAGRIN RD STE A
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-1129
Mailing Address - Country:US
Mailing Address - Phone:440-600-7407
Mailing Address - Fax:440-600-7417
Practice Address - Street 1:7209 CHAGRIN RD STE A
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023-1129
Practice Address - Country:US
Practice Address - Phone:440-600-7407
Practice Address - Fax:440-600-7417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4554111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1225363039OtherNPPES