Provider Demographics
NPI:1952340515
Name:SANDERS, JEREMY J (DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:J
Last Name:SANDERS
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 1:1525 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62439-2260
Mailing Address - Country:US
Mailing Address - Phone:618-943-4949
Mailing Address - Fax:618-943-5858
Practice Address - Street 1:1525 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62439-2260
Practice Address - Country:US
Practice Address - Phone:618-943-4949
Practice Address - Fax:618-943-5858
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003057A111N00000X
IL038-010129111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL660547OtherHEALTHLINK PPO
IL05132005OtherBC/BS PPO
ILK06648Medicare PIN