Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3993 | CO |
NPI | 1003971219 |
---|---|
Provider Name | Dr. Mary Elizabeth Sanders |
First Address | Cascade, CO 80809-1524 |
Second Address | Colorado Springs, CO 80904-2470 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B65742 | (02) | CO |