Healthcare Provider Details

I. General information

NPI: 1366254849
Provider Name (Legal Business Name): LAUREN MICHELLE SANDBERG DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 E SECOND ST
LEXINGTON KY
40508-1926
US

IV. Provider business mailing address

4028 SANTEE WAY
LEXINGTON KY
40513-1348
US

V. Phone/Fax

Practice location:
  • Phone: 859-268-7501
  • Fax:
Mailing address:
  • Phone: 859-494-9950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number296948
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: