Provider Demographics
NPI:1992821870
Name:SANDERSON, STEVEN GARFIRLD (DC)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:GARFIRLD
Last Name:SANDERSON
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 1:350 BRICKYARD RD
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-9421
Mailing Address - Country:US
Mailing Address - Phone:906-249-5630
Mailing Address - Fax:906-249-5631
Practice Address - Street 1:2318 US 41SOUTH
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-9421
Practice Address - Country:US
Practice Address - Phone:906-249-5630
Practice Address - Fax:906-249-5631
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007777111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION46360Medicare ID - Type Unspecified
MIU74401Medicare UPIN