Provider Demographics
NPI:1356892129
Name:SANDERSON, CHANDRA DAWN (DC)
Entity type:Individual
Prefix:
First Name:CHANDRA
Middle Name:DAWN
Last Name:SANDERSON
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 1:18 NORTHSTAR TRL
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-8643
Mailing Address - Country:US
Mailing Address - Phone:828-774-6771
Mailing Address - Fax:
Practice Address - Street 1:289 MERRIMON AVE
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-9252
Practice Address - Country:US
Practice Address - Phone:828-658-3003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3217111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor