Provider Demographics
NPI:1659312668
Name:SPORE, SANDRA LEA (RN DC DABCI DACBN)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LEA
Last Name:SPORE
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Gender:F
Credentials:RN DC DABCI DACBN
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Mailing Address - Street 1:1530 W FRONTAGE RD
Mailing Address - Street 2:VALLEY RIDGE MALL
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082
Mailing Address - Country:US
Mailing Address - Phone:651-439-1013
Mailing Address - Fax:651-439-3465
Practice Address - Street 1:1530 W FRONTAGE RD
Practice Address - Street 2:VALLEY RIDGE MALL
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082
Practice Address - Country:US
Practice Address - Phone:651-439-1013
Practice Address - Fax:651-439-3465
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN2810111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor