Provider Demographics
NPI:1790761237
Name:ANDERSSON, SANDRA E (DC)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:E
Last Name:ANDERSSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:E
Other - Last Name:LEVENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:658 HARLEYSVILLE PIKE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-2886
Mailing Address - Country:US
Mailing Address - Phone:215-256-8006
Mailing Address - Fax:215-256-8111
Practice Address - Street 1:658 HARLEYSVILLE PIKE
Practice Address - Street 2:SUITE 110
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-2886
Practice Address - Country:US
Practice Address - Phone:215-256-8006
Practice Address - Fax:215-256-8111
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-002670L111N00000X
PADC002670L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5968301OtherAETNA
PA0048552000OtherKEYSTONE/INDEPENDENCE BC
PA0048552000OtherKEYSTONE/INDEPENDENCE BC
PA475998Medicare ID - Type Unspecified