Provider Demographics
NPI:1356376016
Name:DAHLSTROM, SANDRA L (DC)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:L
Last Name:DAHLSTROM
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 1:1202 MISSION RD
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-2827
Mailing Address - Country:US
Mailing Address - Phone:724-539-9445
Mailing Address - Fax:724-539-9445
Practice Address - Street 1:1202 MISSION RD
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-2827
Practice Address - Country:US
Practice Address - Phone:724-539-9445
Practice Address - Fax:724-539-9445
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001475L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA169918Medicare ID - Type UnspecifiedCHIROPRACTIC