Provider Demographics
NPI:1841505328
Name:SIDHU, SANDEEP KAUR (DC)
Entity type:Individual
Prefix:DR
First Name:SANDEEP
Middle Name:KAUR
Last Name:SIDHU
Suffix:
Gender:F
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:PO BOX 4278
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-0005
Mailing Address - Country:US
Mailing Address - Phone:209-824-3100
Mailing Address - Fax:209-824-6800
Practice Address - Street 1:708 E YOSEMITE AVE
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-5827
Practice Address - Country:US
Practice Address - Phone:209-824-3100
Practice Address - Fax:209-824-6800
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-09
Last Update Date:2013-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31450111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor