Provider Demographics
NPI:1629127048
Name:SANDER, GREGORY ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALAN
Last Name:SANDER
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 1:508 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ESTHERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:51334-1834
Mailing Address - Country:US
Mailing Address - Phone:712-362-7715
Mailing Address - Fax:712-362-7716
Practice Address - Street 1:508 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ESTHERVILLE
Practice Address - State:IA
Practice Address - Zip Code:51334-1834
Practice Address - Country:US
Practice Address - Phone:712-362-7715
Practice Address - Fax:712-362-7716
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05143111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0243089Medicaid
T01380Medicare UPIN
IA24308Medicare ID - Type Unspecified