Provider Demographics
NPI:1750666582
Name:SANDERS, STEPHEN ELLWOOD (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ELLWOOD
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 1:6724 BLUFFVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3063
Mailing Address - Country:US
Mailing Address - Phone:214-632-6174
Mailing Address - Fax:
Practice Address - Street 1:4620 BRYANT IRVIN RD STE 530
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3611
Practice Address - Country:US
Practice Address - Phone:214-632-6174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11493111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor