Provider Demographics
NPI:1689779704
Name:SANDERS, DAVID L (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
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 1:4350 WADSWORTH BLVD
Mailing Address - Street 2:STE. 301
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4641
Mailing Address - Country:US
Mailing Address - Phone:303-425-0034
Mailing Address - Fax:303-425-5378
Practice Address - Street 1:4350 WADSWORTH BLVD
Practice Address - Street 2:STE. 301
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4641
Practice Address - Country:US
Practice Address - Phone:303-425-0034
Practice Address - Fax:303-425-5378
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO01656111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU03257Medicare UPIN
COC12583Medicare ID - Type UnspecifiedMEDICARE