Provider Demographics
NPI:1851589477
Name:SAUNDERS, DEAN CLARENCE
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:CLARENCE
Last Name:SAUNDERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3169 FERNBROOK LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-5357
Mailing Address - Country:US
Mailing Address - Phone:763-201-1284
Mailing Address - Fax:763-201-1285
Practice Address - Street 1:3169 FERNBROOK LN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-5357
Practice Address - Country:US
Practice Address - Phone:763-201-1284
Practice Address - Fax:763-201-1285
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3304111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU77544Medicare UPIN