Provider Demographics
NPI:1336152974
Name:SANDERS, KIM M (DC)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:M
Last Name:SANDERS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7545 CENTURION PKWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0579
Mailing Address - Country:US
Mailing Address - Phone:904-744-4100
Mailing Address - Fax:904-744-4210
Practice Address - Street 1:7545 CENTURION PKWY
Practice Address - Street 2:SUITE 205
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-0579
Practice Address - Country:US
Practice Address - Phone:904-744-4100
Practice Address - Fax:904-744-4210
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8174111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU84555Medicare UPIN
FL350053044Medicare PIN