Provider Demographics
NPI:1083739585
Name:ANDERSON, SETH JACOB (DC)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:JACOB
Last Name:ANDERSON
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 1:7121 27TH ST W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4623
Mailing Address - Country:US
Mailing Address - Phone:253-566-4744
Mailing Address - Fax:253-566-6744
Practice Address - Street 1:7121 27TH ST W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4623
Practice Address - Country:US
Practice Address - Phone:253-566-4744
Practice Address - Fax:253-566-6744
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034356111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
68854004Medicare ID - Type Unspecified