Provider Demographics
NPI:1871541151
Name:SANFORD, RICHARD F (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:F
Last Name:SANFORD
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 1:110 OAK PARK DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063
Mailing Address - Country:US
Mailing Address - Phone:803-749-8960
Mailing Address - Fax:803-749-8961
Practice Address - Street 1:110 OAK PARK DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2852
Practice Address - Country:US
Practice Address - Phone:803-749-8960
Practice Address - Fax:803-749-8961
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1410111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1410Medicaid
SCCH1410Medicaid
SCU12505Medicare UPIN