Provider Demographics
NPI:1275605313
Name:ANDERSON, PEGGY J (DC)
Entity Type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:J
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 1:5260 S ULSTER ST APT 3406
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2875
Mailing Address - Country:US
Mailing Address - Phone:719-331-9867
Mailing Address - Fax:
Practice Address - Street 1:5260 S ULSTER ST APT 3406
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2875
Practice Address - Country:US
Practice Address - Phone:719-331-9867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU58111Medicare UPIN
COK0213Medicare ID - Type Unspecified