Provider Demographics
NPI:1407095318
Name:ANDERSON, JOSEPH FULLERTON (DC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:FULLERTON
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 1:16331 HERITAGE PL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7714
Mailing Address - Country:US
Mailing Address - Phone:907-694-8881
Mailing Address - Fax:907-694-8892
Practice Address - Street 1:16331 HERITAGE PL
Practice Address - Street 2:SUITE 101
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7714
Practice Address - Country:US
Practice Address - Phone:907-694-8881
Practice Address - Fax:907-694-8892
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7225836-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor