Provider Demographics
NPI:1699748665
Name:GEISSER, SANFORD LYLE (DC)
Entity type:Individual
Prefix:MR
First Name:SANFORD
Middle Name:LYLE
Last Name:GEISSER
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 1:650 S. MOUNT JULIET RD, SUITE 105
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122
Mailing Address - Country:US
Mailing Address - Phone:615-288-4823
Mailing Address - Fax:615-288-4921
Practice Address - Street 1:650 S. MOUNT JULIET RD, SUITE 105
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122
Practice Address - Country:US
Practice Address - Phone:615-288-4823
Practice Address - Fax:615-288-4921
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001381111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4025433OtherBLUE CROSS PROVIDER NUMBE
TNU59938Medicare UPIN
TN3679940Medicare ID - Type Unspecified