Provider Demographics
NPI:1740394568
Name:SANDERS FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:SANDERS FAMILY CHIROPRACTIC, LLC
Other - Org Name:SANDERS FAMILY CHIROPRACTIC - VINCENNES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-943-4949
Mailing Address - Street 1:1525 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62439-2260
Mailing Address - Country:US
Mailing Address - Phone:618-943-4949
Mailing Address - Fax:618-943-5858
Practice Address - Street 1:1525 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62439-2260
Practice Address - Country:US
Practice Address - Phone:618-943-4949
Practice Address - Fax:618-943-5858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3516-2449111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05132005OtherBC/BS
IL208976Medicare PIN