Provider Demographics
NPI:1356745681
Name:SONDER CHIROPRACTIC, P.A.
Entity type:Organization
Organization Name:SONDER CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:SONDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-326-8283
Mailing Address - Street 1:1049 COMSTOCK DR
Mailing Address - Street 2:107
Mailing Address - City:DEER RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:56636-9708
Mailing Address - Country:US
Mailing Address - Phone:218-246-4458
Mailing Address - Fax:218-246-3171
Practice Address - Street 1:1049 COMSTOCK DR
Practice Address - Street 2:107
Practice Address - City:DEER RIVER
Practice Address - State:MN
Practice Address - Zip Code:56636-9708
Practice Address - Country:US
Practice Address - Phone:218-246-4458
Practice Address - Fax:218-246-3171
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SONDER CHIROPRACTIC, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-15
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4059302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization