Provider Demographics
NPI:1659342996
Name:SANDERS, KEITH R (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:R
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 1:10301 S. DEANZA BLVD
Mailing Address - Street 2:#3
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3027
Mailing Address - Country:US
Mailing Address - Phone:408-252-3292
Mailing Address - Fax:
Practice Address - Street 1:10301 S. DEANZA BLVD
Practice Address - Street 2:#3
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3027
Practice Address - Country:US
Practice Address - Phone:408-252-3292
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0142250111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATO5286Medicare UPIN
CADC0142250Medicare ID - Type Unspecified