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General NPI Number Information
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NPI Number | 1083912489
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Entity Type | Organization
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Legal Business Name | SANDERS CHIROPRACTIC, INC.
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Dates
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Enumeration Date | 03/09/2011
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Last Update Date | 01/06/2012
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Provider Practice Location Address
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Address Line | 7545 CENTURION PKWY SUITE 205
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City | JACKSONVILLE
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State | FL
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Zip | 32256-0579
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Country | US
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Telephone | 904-744-4100
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Fax | 904-744-4210
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Provider Business Mailing Address
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Address Line | 7545 CENTURION PKWY SUITE 205
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City | JACKSONVILLE
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State | FL
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Zip | 32256-0579
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Country | US
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Telephone | 904-744-4100
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Fax | 904-744-4210
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Authorized Official
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Title or Position | OWNER/CHIROPRACTIC PHYSICIAN
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Name | MR. KIM M SANDERS JR.
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Credential | D.C
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Telephone | 904-744-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH8174
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License Number State | FL
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