Provider Demographics
NPI:1669518114
Name:SANDAINE, RANDY L (ND)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:L
Last Name:SANDAINE
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-2948
Mailing Address - Country:US
Mailing Address - Phone:509-684-1104
Mailing Address - Fax:
Practice Address - Street 1:234 N OAK ST
Practice Address - Street 2:
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-2948
Practice Address - Country:US
Practice Address - Phone:509-684-1104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00000717208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice