Provider Demographics
NPI:1629141072
Name:SANDERSON, STEVE DOUGLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:DOUGLAS
Last Name:SANDERSON
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 1:22811 MERIDIAN AVE E
Mailing Address - Street 2:UNIT B
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-9275
Mailing Address - Country:US
Mailing Address - Phone:253-847-7517
Mailing Address - Fax:253-847-7467
Practice Address - Street 1:22811 MERIDIAN AVE E
Practice Address - Street 2:UNIT B
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-9275
Practice Address - Country:US
Practice Address - Phone:253-847-7517
Practice Address - Fax:253-847-7467
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1162111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0170477OtherLABOR AND INDUSTRIES
WA0170477OtherLABOR AND INDUSTRIES
AB33211Medicare ID - Type Unspecified