Provider Demographics
NPI:1619044179
Name:SANDERS, R ERIC (DC)
Entity Type:Individual
Prefix:
First Name:R
Middle Name:ERIC
Last Name:SANDERS
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 1:180 W GORDON AVE
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-2384
Mailing Address - Country:US
Mailing Address - Phone:801-546-4500
Mailing Address - Fax:801-544-7947
Practice Address - Street 1:180 W GORDON AVE
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-2384
Practice Address - Country:US
Practice Address - Phone:801-546-4500
Practice Address - Fax:801-544-7947
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT52269381202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005779901Medicare PIN