Provider Demographics
NPI:1376606319
Name:ANDERSON, JEANNETTE M (DC)
Entity Type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:M
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 1:39 WEST 56TH ST
Mailing Address - Street 2:FOURTH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019
Mailing Address - Country:US
Mailing Address - Phone:212-581-5776
Mailing Address - Fax:212-247-1240
Practice Address - Street 1:39 WEST 56TH ST.
Practice Address - Street 2:FOURTH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-581-5776
Practice Address - Fax:212-247-1240
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68181111N00000X
NY6818-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
5656002003OtherCIGNA ID
5801318OtherGHI ID
X48901OtherEMPIRE BCBS ID
050006818NY01OtherANTHEM
5656002003OtherCIGNA ID