Provider Demographics
NPI:1750567632
Name:VANDER SANDEN, JAMIE L (DC)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:L
Last Name:VANDER SANDEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HORTONVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54944-0301
Mailing Address - Country:US
Mailing Address - Phone:920-450-1655
Mailing Address - Fax:
Practice Address - Street 1:315 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HORTONVILLE
Practice Address - State:WI
Practice Address - Zip Code:54944-0301
Practice Address - Country:US
Practice Address - Phone:920-450-1655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4374111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor