Provider Demographics
NPI:1770300188
Name:SANDY, CARSON (DC)
Entity type:Individual
Prefix:
First Name:CARSON
Middle Name:
Last Name:SANDY
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 1:222 W BEECH ST
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IN
Mailing Address - Zip Code:47882-1462
Mailing Address - Country:US
Mailing Address - Phone:812-268-3400
Mailing Address - Fax:
Practice Address - Street 1:222 W BEECH ST
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IN
Practice Address - Zip Code:47882-1462
Practice Address - Country:US
Practice Address - Phone:812-268-3400
Practice Address - Fax:812-268-5713
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003466A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor