MEDICARE: DR. LEAMON C. SANDIFER DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NN0400X	Neurology Chiropractor	CH00000764	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CH00000764	OTHER	WA	STATE OF WA

General Provider Information

NPI Number	:	1447376173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEAMON C. SANDIFER DC

Provider Business Mailing Address
First Line	:	PO BOX 5310
Second Line	:
City	:	LACEY
State	:	WA
Zip	:	98509-5310
Country	:	US
Telephone Number	:	360-491-6310
Fax Number	:

Provider Business Practice Location Address
First Line	:	704 LILLY RD SE
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98501-2115
Country	:	US
Telephone Number	:	360-491-6310
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	07/08/2007

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