Provider Demographics
NPI:1730628009
Name:SANDA, JILLIAN TARA (DC)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:TARA
Last Name:SANDA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:TARA
Other - Last Name:GELB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1696 SE HILLMOOR DR STE C
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7699
Mailing Address - Country:US
Mailing Address - Phone:772-335-3222
Mailing Address - Fax:772-335-3793
Practice Address - Street 1:1696 SE HILLMOOR DR STE C
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7699
Practice Address - Country:US
Practice Address - Phone:772-335-3222
Practice Address - Fax:772-335-3793
Is Sole Proprietor?:No
Enumeration Date:2017-02-19
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00742400111N00000X
FLCH13900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor