Provider Demographics
NPI:1558434423
Name:ASHBROOK, SANDRA T (DC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:T
Last Name:ASHBROOK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:DEE
Other - Last Name:TALT ASHBROOK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:7315 9TH AVE NW
Mailing Address - Street 2:BRADENTON
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-1510
Mailing Address - Country:US
Mailing Address - Phone:941-778-7744
Mailing Address - Fax:
Practice Address - Street 1:5374 GULF DR
Practice Address - Street 2:
Practice Address - City:HOLMES BEACH
Practice Address - State:FL
Practice Address - Zip Code:34217-1775
Practice Address - Country:US
Practice Address - Phone:941-778-7744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2010-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9437111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCH0168Medicaid
FLCH9437OtherLICENSE
FLCH9437OtherLICENSE
AK200174929OtherTIN