Provider Demographics
NPI:1093908931
Name:ANDERSON, CAROLYN ROSE (DC)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:ROSE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8041 HOSBROOK RD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236
Mailing Address - Country:US
Mailing Address - Phone:513-793-6104
Mailing Address - Fax:513-793-1478
Practice Address - Street 1:8041 HOSBROOK RD
Practice Address - Street 2:SUITE 404
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236
Practice Address - Country:US
Practice Address - Phone:513-793-6104
Practice Address - Fax:513-793-1478
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2995111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4032181Medicare UPIN