Provider Demographics
NPI:1821104050
Name:SANFORD CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:SANFORD CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-879-8040
Mailing Address - Street 1:PO BOX 880640
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80488-0640
Mailing Address - Country:US
Mailing Address - Phone:970-879-8040
Mailing Address - Fax:970-879-8041
Practice Address - Street 1:1125 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487
Practice Address - Country:US
Practice Address - Phone:970-879-8040
Practice Address - Fax:970-879-8041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4042111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO46343Medicare ID - Type Unspecified
COU41625Medicare UPIN
CO502858Medicare ID - Type Unspecified
CO502848Medicare ID - Type Unspecified