Provider Demographics
NPI:1891822193
Name:SANDERS CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:SANDERS CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-475-2455
Mailing Address - Street 1:2812 W COLORADO AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-2470
Mailing Address - Country:US
Mailing Address - Phone:719-475-2455
Mailing Address - Fax:719-475-2254
Practice Address - Street 1:2812 W COLORADO AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-2470
Practice Address - Country:US
Practice Address - Phone:719-475-2455
Practice Address - Fax:719-475-2254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3933111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COB65742Medicare UPIN
CO47833Medicare PIN