Healthcare Provider Details

I. General information

NPI: 1487223137
Provider Name (Legal Business Name): SANDRA WASCHINEK DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19550 E 39TH ST S STE 235
INDEPENDENCE MO
64057-2305
US

IV. Provider business mailing address

601 SE MELODY LN STE 101
LEES SUMMIT MO
64063-4804
US

V. Phone/Fax

Practice location:
  • Phone: 816-795-5300
  • Fax:
Mailing address:
  • Phone: 816-795-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2021016058
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: