Provider Demographics
NPI:1841561727
Name:SAANDE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:SAANDE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYLYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAANDE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-438-0460
Mailing Address - Street 1:20650 QUENTIN AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-9037
Mailing Address - Country:US
Mailing Address - Phone:651-438-0460
Mailing Address - Fax:651-437-6442
Practice Address - Street 1:1300 VERMILLION ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-2861
Practice Address - Country:US
Practice Address - Phone:651-438-0460
Practice Address - Fax:651-437-6442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2597111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350002177Medicare PIN