Provider Demographics
NPI:1760592646
Name:SAUDER, STANLEY EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:EDWARD
Last Name:SAUDER
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 1:7239 SAWMILL RD
Mailing Address - Street 2:STE 110
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-5017
Mailing Address - Country:US
Mailing Address - Phone:614-848-4111
Mailing Address - Fax:614-848-4439
Practice Address - Street 1:5915 KARL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-2664
Practice Address - Country:US
Practice Address - Phone:614-848-4111
Practice Address - Fax:614-848-4439
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1199111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0651496Medicaid
OHT48522Medicare UPIN
OHSA-0594281Medicare ID - Type Unspecified