Provider Demographics
NPI:1295747301
Name:SANDS, CARRIE THERESA (DC)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:THERESA
Last Name:SANDS
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 1:635 N 9TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-5896
Mailing Address - Country:US
Mailing Address - Phone:269-372-2900
Mailing Address - Fax:269-372-0900
Practice Address - Street 1:635 N 9TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-5896
Practice Address - Country:US
Practice Address - Phone:269-372-2900
Practice Address - Fax:269-372-0900
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICS008469111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
11287788OtherCAQH
MI4430181OtherOTHER
MI1295747301OtherNPI (TYPE 1)
MI1770534976OtherGROUP NPI
MI950C912820OtherOTHER
N43520003OtherMEDICARE PTAN
MI47-0990163OtherEIN
MI1770534976OtherGROUP NPI
MIP2776001Medicare PIN