Provider Demographics
NPI:1013116466
Name:SANDERFORD, KATHLEEN FAY (DC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:FAY
Last Name:SANDERFORD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1295
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46015-1295
Mailing Address - Country:US
Mailing Address - Phone:765-683-0845
Mailing Address - Fax:
Practice Address - Street 1:516 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:IN
Practice Address - Zip Code:46540-9701
Practice Address - Country:US
Practice Address - Phone:574-825-9124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001933A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor