Provider Demographics
NPI:1447685417
Name:SANDBERG, YASHA (DC)
Entity type:Individual
Prefix:
First Name:YASHA
Middle Name:
Last Name:SANDBERG
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 1:17848 MULQUEEN RD SE
Mailing Address - Street 2:
Mailing Address - City:RAINIER
Mailing Address - State:WA
Mailing Address - Zip Code:98576-9675
Mailing Address - Country:US
Mailing Address - Phone:360-446-4514
Mailing Address - Fax:
Practice Address - Street 1:17848 MULQUEEN RD SE
Practice Address - Street 2:
Practice Address - City:RAINIER
Practice Address - State:WA
Practice Address - Zip Code:98576-9675
Practice Address - Country:US
Practice Address - Phone:360-446-4514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033772111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor