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General NPI Number Information
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NPI Number | 1730628009
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Entity Type | Individual
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Provider Name | JILLIAN TARA SANDA D.C.
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Gender | Female
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Dates
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Enumeration Date | 02/19/2017
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 1696 SE HILLMOOR DR STE C
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-7699
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Country | US
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Telephone | 772-335-3222
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Fax | 772-335-3793
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Provider Business Mailing Address
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Address Line | 1696 SE HILLMOOR DR STE C
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-7699
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Country | US
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Telephone | 772-335-3222
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Fax | 772-335-3793
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 38MC00742400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH13900
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License Number State | FL
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