Provider Demographics
NPI:1912050220
Name:SANDELL, JOSH JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSH
Middle Name:JAMES
Last Name:SANDELL
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 1:11463 76TH CT
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55301-4525
Mailing Address - Country:US
Mailing Address - Phone:763-315-0466
Mailing Address - Fax:
Practice Address - Street 1:7372 KIRKWOOD CT
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-5202
Practice Address - Country:US
Practice Address - Phone:763-315-0466
Practice Address - Fax:763-315-0884
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4196111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU95757Medicare UPIN