Provider Demographics
NPI:1154402162
Name:SANBORN, ROBERT J (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:SANBORN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1792 WOODSTOCK RD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2199
Mailing Address - Country:US
Mailing Address - Phone:770-579-3165
Mailing Address - Fax:770-642-7774
Practice Address - Street 1:1792 WOODSTOCK RD
Practice Address - Street 2:SUITE 450
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2199
Practice Address - Country:US
Practice Address - Phone:770-579-3165
Practice Address - Fax:770-642-7774
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA005115111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCCWWMedicare ID - Type Unspecified