Provider Demographics
NPI:1639448756
Name:SANDER CHIROPRACTIC
Entity Type:Organization
Organization Name:SANDER CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-362-4139
Mailing Address - Street 1:15 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:ESTHERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:51334-2220
Mailing Address - Country:US
Mailing Address - Phone:712-362-4139
Mailing Address - Fax:
Practice Address - Street 1:15 S 9TH ST
Practice Address - Street 2:
Practice Address - City:ESTHERVILLE
Practice Address - State:IA
Practice Address - Zip Code:51334-2220
Practice Address - Country:US
Practice Address - Phone:712-362-4139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05143261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0243089Medicaid
IA24308OtherMEDICARE ID-TYPE UNSPECIFIED
IA0243089Medicaid