Healthcare Provider Details

I. General information

NPI: 1487845616
Provider Name (Legal Business Name): SANDELL FAMILY CHIROPRACTIC LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 MAIN ST.
PECATONICA IL
61063-0809
US

IV. Provider business mailing address

PO BOX 809
PECATONICA IL
61063-0809
US

V. Phone/Fax

Practice location:
  • Phone: 815-239-1101
  • Fax: 815-239-1113
Mailing address:
  • Phone: 815-239-1101
  • Fax: 815-239-1113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. DONALD WILLIAM SANDELL
Title or Position: PRESIDENT
Credential: D.C.
Phone: 815-239-1101