Provider Demographics
NPI:1811225501
Name:SANDS, JUSTIN RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:RYAN
Last Name:SANDS
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 1:407 W BRIDGE RD
Mailing Address - Street 2:STE 8
Mailing Address - City:POLK CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50226
Mailing Address - Country:US
Mailing Address - Phone:515-984-6484
Mailing Address - Fax:515-257-2740
Practice Address - Street 1:407 W BRIDGE RD
Practice Address - Street 2:STE 8
Practice Address - City:POLK CITY
Practice Address - State:IA
Practice Address - Zip Code:50226
Practice Address - Country:US
Practice Address - Phone:515-984-6484
Practice Address - Fax:515-257-2740
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007262111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor