Provider Demographics
NPI:1144399692
Name:ANDERSON, ROGER R (DC)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:R
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 1:300 E. FIRST ST.
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030
Mailing Address - Country:US
Mailing Address - Phone:805-486-8311
Mailing Address - Fax:805-486-3457
Practice Address - Street 1:300 E. FIRST ST.
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030
Practice Address - Country:US
Practice Address - Phone:805-486-8311
Practice Address - Fax:805-486-3457
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10290111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC10290Medicare PIN