Provider Demographics
NPI:1457549867
Name:SANDIFER CHIROPRACTIC CLINIC, INC. P.S.
Entity Type:Organization
Organization Name:SANDIFER CHIROPRACTIC CLINIC, INC. P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:LEAMON
Authorized Official - Middle Name:C
Authorized Official - Last Name:SANDIFER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-491-6310
Mailing Address - Street 1:PO BOX 5310
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98509-5310
Mailing Address - Country:US
Mailing Address - Phone:360-491-6310
Mailing Address - Fax:
Practice Address - Street 1:704 LILLY RD SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-2115
Practice Address - Country:US
Practice Address - Phone:360-491-6310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00000764111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACH0000764OtherLICENSE