Provider Demographics
NPI:1336237361
Name:IOELE, SANDRA ANNE (CHIROPRACTOR)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:ANNE
Last Name:IOELE
Suffix:
Gender:F
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2646 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-1638
Mailing Address - Country:US
Mailing Address - Phone:626-441-2264
Mailing Address - Fax:626-441-3533
Practice Address - Street 1:2646 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-1638
Practice Address - Country:US
Practice Address - Phone:626-441-2264
Practice Address - Fax:626-441-3533
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25065111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU71525Medicare UPIN
CAWDC25065AMedicare ID - Type Unspecified