Provider Demographics
NPI:1255477410
Name:ANDERSON, RODNEY L (DC)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:L
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:PO BOX 589
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:AK
Mailing Address - Zip Code:99833-0589
Mailing Address - Country:US
Mailing Address - Phone:907-772-4291
Mailing Address - Fax:907-772-3085
Practice Address - Street 1:103 FRAM ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:AK
Practice Address - Zip Code:99833
Practice Address - Country:US
Practice Address - Phone:907-772-4291
Practice Address - Fax:907-772-3085
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK309111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
920156015OtherTAX ID #
AKCH0309Medicaid
AKCH0309Medicaid