MEDICARE: DR. CHARLES MICHAEL SANDERS D.C.

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	111NS0005X	Sports Physician Chiropractor	9292	TX

General Provider Information

NPI Number	:	1922117167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES MICHAEL SANDERS D.C.

Provider Business Mailing Address
First Line	:	1618 S MASON RD
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-4563
Country	:	US
Telephone Number	:	281-693-0002
Fax Number	:	281-693-0508

Provider Business Practice Location Address
First Line	:	1618 S MASON RD
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-4563
Country	:	US
Telephone Number	:	281-693-0002
Fax Number	:	281-693-0508

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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