Provider Demographics
NPI:1972522795
Name:SANFORD, JAMES M JR (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:SANFORD
Suffix:JR
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 1:2450 E WHITMORE AVE
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-2637
Mailing Address - Country:US
Mailing Address - Phone:209-537-4515
Mailing Address - Fax:209-537-1354
Practice Address - Street 1:2450 E WHITMORE AVE
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-2637
Practice Address - Country:US
Practice Address - Phone:209-537-4515
Practice Address - Fax:209-537-1354
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22841111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0228410Medicare ID - Type Unspecified
CAU54315Medicare UPIN