Provider Demographics
NPI:1558457291
Name:SANDBERG, GABRIELLE MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:MARIE
Last Name:SANDBERG
Suffix:
Gender:F
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:PO BOX 379
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-0379
Mailing Address - Country:US
Mailing Address - Phone:515-276-5135
Mailing Address - Fax:515-276-5167
Practice Address - Street 1:5800 MERLE HAY RD STE 10
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-1217
Practice Address - Country:US
Practice Address - Phone:515-276-5135
Practice Address - Fax:515-276-5167
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAAO5988111N00000X
IAA05988111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA58488Medicare ID - Type Unspecified