Healthcare Provider Details

I. General information

NPI: 1154435337
Provider Name (Legal Business Name): JOHN LLOYD SANDIFER JR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 HWY 6 W
BATESVILLE MS
38606-2508
US

IV. Provider business mailing address

PO BOX 754
BATESVILLE MS
38606-0754
US

V. Phone/Fax

Practice location:
  • Phone: 662-563-1102
  • Fax: 662-563-1178
Mailing address:
  • Phone: 662-563-1102
  • Fax: 662-563-1178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0901
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: