Healthcare Provider Details

I. General information

NPI: 1013222835
Provider Name (Legal Business Name): KRISTINE E. SANDERS D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: K. ERICA SANDERS D.C.

II. Dates (important events)

Enumeration Date: 08/17/2010
Last Update Date: 08/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1497 WHITE BEAR AVE N
SAINT PAUL MN
55106-2414
US

IV. Provider business mailing address

5115 EXCELSIOR BLVD
MINNEAPOLIS MN
55416-2906
US

V. Phone/Fax

Practice location:
  • Phone: 651-705-6701
  • Fax:
Mailing address:
  • Phone: 651-431-1962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5265
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number5265
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number5265
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: