Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 006530 | MO |
NPI | 1003957440 |
---|---|
Provider Name | Dr. David Lee Sanders |
First Address | Independence, MO 64057-2602 |
Second Address | Independence, MO 64057-2602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2007 |
Last Update Date | 05/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25036018 | BLUE CROSS BLUE SHIELD (01) | MO |