Provider Demographics
NPI:1932213519
Name:SANDERS, JACINDA J (DC)
Entity Type:Individual
Prefix:DR
First Name:JACINDA
Middle Name:J
Last Name:SANDERS
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 1:609 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61244-1323
Mailing Address - Country:US
Mailing Address - Phone:309-755-8220
Mailing Address - Fax:309-755-8221
Practice Address - Street 1:609 15TH AVE
Practice Address - Street 2:
Practice Address - City:EAST MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61244-1323
Practice Address - Country:US
Practice Address - Phone:309-755-8220
Practice Address - Fax:309-755-8221
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009639111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL8132017OtherBCBS
ILU89296Medicare UPIN
ILK09054Medicare PIN