Provider Demographics
NPI:1841312105
Name:SCHANK, SANDRA K (DOM)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:K
Last Name:SCHANK
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 FIREROCK PL
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-1325
Mailing Address - Country:US
Mailing Address - Phone:505-473-3518
Mailing Address - Fax:
Practice Address - Street 1:1911 5TH ST
Practice Address - Street 2:SUITE 207
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5403
Practice Address - Country:US
Practice Address - Phone:505-670-2743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM498171100000X
NM173225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist