Provider Demographics
NPI:1659866259
Name:SANDOVAL, ESTEBAN (DC)
Entity type:Individual
Prefix:DR
First Name:ESTEBAN
Middle Name:
Last Name:SANDOVAL
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 1:4195 N VIKING WAY STE F
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-1470
Mailing Address - Country:US
Mailing Address - Phone:562-420-2112
Mailing Address - Fax:
Practice Address - Street 1:4195 N VIKING WAY STE F
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-1470
Practice Address - Country:US
Practice Address - Phone:562-420-2112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34256111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty