MEDICARE: DR. SANDRA JEAN POTTHOFF D.C.

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	111N00000X	Chiropractor	9896	FL

General Provider Information

NPI Number	:	1962505263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA JEAN POTTHOFF D.C.

Provider Business Mailing Address
First Line	:	7294 TOPAZ DR
Second Line	:
City	:	GRANT
State	:	FL
Zip	:	32949-8323
Country	:	US
Telephone Number	:	305-783-8333
Fax Number	:

Provider Business Practice Location Address
First Line	:	8000 RON BEATTY BLVD STE B-1
Second Line	:
City	:	MICCO
State	:	FL
Zip	:	32976-7471
Country	:	US
Telephone Number	:	305-783-8333
Fax Number	:

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	10/21/2025

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