Provider Demographics
NPI:1356392450
Name:SANKS, TREVOR D (DC)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:D
Last Name:SANKS
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 1:1089 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-4804
Mailing Address - Country:US
Mailing Address - Phone:619-588-1100
Mailing Address - Fax:619-588-1187
Practice Address - Street 1:1089 BROADWAY
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-4804
Practice Address - Country:US
Practice Address - Phone:619-588-1100
Practice Address - Fax:619-588-1187
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16046111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC16046Medicare ID - Type Unspecified