Provider Demographics
NPI:1689715419
Name:SANDS CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:SANDS CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:SANDS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-271-8100
Mailing Address - Street 1:303 SW 16TH ST
Mailing Address - Street 2:#7
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7173
Mailing Address - Country:US
Mailing Address - Phone:479-271-8100
Mailing Address - Fax:
Practice Address - Street 1:303 SW 16TH ST
Practice Address - Street 2:#7
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7173
Practice Address - Country:US
Practice Address - Phone:479-271-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1315111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C290Medicare ID - Type Unspecified