Provider Demographics
NPI:1053512509
Name:SANNA, DEAN BARTHOLOMEW (DC)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:BARTHOLOMEW
Last Name:SANNA
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 1:578 SPARROW CIRCLE
Mailing Address - Street 2:
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147
Mailing Address - Country:US
Mailing Address - Phone:970-731-4357
Mailing Address - Fax:970-731-4358
Practice Address - Street 1:4760 W HWY 160
Practice Address - Street 2:SUITE B
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147
Practice Address - Country:US
Practice Address - Phone:970-731-4357
Practice Address - Fax:970-731-4358
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4109111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor