Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC0142250 | CA |
NPI | 1659342996 |
---|---|
Provider Name | Dr. Keith R Sanders |
First Address | Cupertino, CA 95014-3027 |
Second Address | Cupertino, CA 95014-3027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
TO5286 | (02) | CA |