MEDICARE: MRS. SANDRA MARIE STANTON DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301005877	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00099912	OTHER	MI	MEDICARE RAIL ROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	03995	OTHER	MI	PRIORITY HEALTH

General Provider Information

NPI Number	:	1447234745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA MARIE STANTON DC

Provider Business Mailing Address
First Line	:	PO BOX 803
Second Line	:
City	:	PINCONNING
State	:	MI
Zip	:	48650-0803
Country	:	US
Telephone Number	:	616-863-9482
Fax Number	:	616-863-9486

Provider Business Practice Location Address
First Line	:	500 NORTHLAND DR NE
Second Line	:	STE 200
City	:	ROCKFORD
State	:	MI
Zip	:	49341-7634
Country	:	US
Telephone Number	:	616-863-9482
Fax Number	:	616-863-9482

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	07/08/2007

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