Provider Demographics
NPI:1689740474
Name:SANDBERG-HAYES, MARTHA ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:ANN
Last Name:SANDBERG-HAYES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9008 THORNTON RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-1819
Mailing Address - Country:US
Mailing Address - Phone:209-952-6639
Mailing Address - Fax:209-952-0914
Practice Address - Street 1:9008 THORNTON RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-1819
Practice Address - Country:US
Practice Address - Phone:209-952-6639
Practice Address - Fax:209-952-0914
Is Sole Proprietor?:No
Enumeration Date:2006-11-26
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 20775111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC020775Medicare ID - Type Unspecified
CAU09116Medicare UPIN