Provider Demographics
NPI:1124322664
Name:SANDEZ, JOSE LUIS (DC)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:LUIS
Last Name:SANDEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 EVANS RD
Mailing Address - Street 2:STE. 150
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-9653
Mailing Address - Country:US
Mailing Address - Phone:919-535-3091
Mailing Address - Fax:919-535-3099
Practice Address - Street 1:1616 EVANS RD
Practice Address - Street 2:STE. 150
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-9653
Practice Address - Country:US
Practice Address - Phone:919-535-3091
Practice Address - Fax:919-535-3099
Is Sole Proprietor?:No
Enumeration Date:2010-12-24
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4076111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor