Provider Demographics
NPI:1760519300
Name:SANDBERG, DAWN DENISE (DC)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:DENISE
Last Name:SANDBERG
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 1:4849 WILLIAMSBURG LN UNIT 245
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-4612
Mailing Address - Country:US
Mailing Address - Phone:619-261-7415
Mailing Address - Fax:
Practice Address - Street 1:7540 METROPOLITAN DR STE 109
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4416
Practice Address - Country:US
Practice Address - Phone:619-294-9342
Practice Address - Fax:619-294-9365
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor