Provider Demographics
NPI:1396175402
Name:SANDERS, ANDREW CLARK (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:CLARK
Last Name:SANDERS
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 1:4234 CENTENNIAL CT
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-2433
Mailing Address - Country:US
Mailing Address - Phone:314-623-8430
Mailing Address - Fax:
Practice Address - Street 1:971 N DELAWARE ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3377
Practice Address - Country:US
Practice Address - Phone:317-648-5631
Practice Address - Fax:317-743-1394
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003349A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH282320Medicare PIN