Provider Demographics
NPI:1932297785
Name:SANDERS CHIROPRACTIC CENTER, PA
Entity Type:Organization
Organization Name:SANDERS CHIROPRACTIC CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:806-687-7417
Mailing Address - Street 1:5805 64TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-2707
Mailing Address - Country:US
Mailing Address - Phone:806-687-7417
Mailing Address - Fax:
Practice Address - Street 1:5805 64TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2707
Practice Address - Country:US
Practice Address - Phone:806-687-7417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC6764111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU58282Medicare UPIN
TX00602VMedicare PIN