Provider Demographics
NPI:1659496834
Name:SANDOZ, JOHN E (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:SANDOZ
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 1:2057 BRIGGS ROAD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054
Mailing Address - Country:US
Mailing Address - Phone:856-206-9560
Mailing Address - Fax:856-206-9701
Practice Address - Street 1:2057 BRIGGS ROAD
Practice Address - Street 2:SUITE 204
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054
Practice Address - Country:US
Practice Address - Phone:856-206-9560
Practice Address - Fax:856-206-9701
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00198700111N00000X
PADC002056L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ427243M2KMedicare ID - Type Unspecified