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General NPI Number Information
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NPI Number | 1962505263
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Entity Type | Individual
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Provider Name | SANDRA JEAN POTTHOFF D.C.
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Gender | Female
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 8000 RON BEATTY BLVD STE B-1
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City | MICCO
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State | FL
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Zip | 32976-7471
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Country | US
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Telephone | 305-783-8333
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Fax |
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Provider Business Mailing Address
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Address Line | 7294 TOPAZ DR
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City | GRANT
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State | FL
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Zip | 32949-8323
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Country | US
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Telephone | 305-783-8333
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Fax |
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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 | 9896
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License Number State | FL
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