Provider Demographics
NPI:1003456245
Name:ANDERSON CHIROPRACTIC HEALTH AND WELLNESS MECCA
Entity Type:Organization
Organization Name:ANDERSON CHIROPRACTIC HEALTH AND WELLNESS MECCA
Other - Org Name:ANDERSON CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWIN CLAYTON
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:469-407-8379
Mailing Address - Street 1:210 W DAVIS ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-4648
Mailing Address - Country:US
Mailing Address - Phone:972-807-9355
Mailing Address - Fax:
Practice Address - Street 1:210 W DAVIS ST STE 100
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-4648
Practice Address - Country:US
Practice Address - Phone:972-807-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-15
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty