Provider Demographics
NPI:1184079881
Name:SANDERSON, JORDAN (DC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:SANDERSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8240 LAKEWOOD RANCH BLVD UNIT 306
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5278
Mailing Address - Country:US
Mailing Address - Phone:717-580-4189
Mailing Address - Fax:
Practice Address - Street 1:7222 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-5567
Practice Address - Country:US
Practice Address - Phone:941-921-4884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-01
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11618111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor