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General NPI Number Information
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NPI Number | 1154039634
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Entity Type | Organization
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Legal Business Name | 100 CHIRO MARTIN SANDERS PLLC
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Dates
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Enumeration Date | 11/14/2022
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Last Update Date | 11/14/2022
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Provider Practice Location Address
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Address Line | 1605 COUNTY ROAD 220 STE 165
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City | FLEMING ISLAND
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State | FL
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Zip | 32003-4910
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Country | US
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Telephone | 689-218-0851
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Fax |
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Provider Business Mailing Address
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Address Line | 1605 COUNTY ROAD 220 STE 165
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City | FLEMING ISLAND
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State | FL
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Zip | 32003-4910
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. AYLA ROSE SANDERS
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Credential |
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Telephone | 904-659-6664
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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 |
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License Number State |
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