Healthcare Provider Details

I. General information

NPI: 1962401661
Provider Name (Legal Business Name): TODD MICHAEL SANDS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 10/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2518 SUPERIOR DR NW SUITE 101B
ROCHESTER MN
55901-1988
US

IV. Provider business mailing address

2518 SUPERIOR DR NW SUITE 101B
ROCHESTER MN
55901-1988
US

V. Phone/Fax

Practice location:
  • Phone: 507-287-6041
  • Fax: 507-287-6438
Mailing address:
  • Phone: 507-287-6041
  • Fax: 507-287-6438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3017
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberA5626
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: