Provider Demographics
NPI:1528040466
Name:SANDE, DOUGLAS ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ALAN
Last Name:SANDE
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 1:41 CENTER ST W
Mailing Address - Street 2:
Mailing Address - City:BRITT
Mailing Address - State:IA
Mailing Address - Zip Code:50423-1656
Mailing Address - Country:US
Mailing Address - Phone:641-843-3600
Mailing Address - Fax:
Practice Address - Street 1:41 CENTER ST W
Practice Address - Street 2:
Practice Address - City:BRITT
Practice Address - State:IA
Practice Address - Zip Code:50423-1656
Practice Address - Country:US
Practice Address - Phone:641-843-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05142111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0232256Medicaid
IA0232256Medicaid