Provider Demographics
NPI:1417463498
Name:ANDERSON, PORCHA (DC)
Entity Type:Individual
Prefix:
First Name:PORCHA
Middle Name:
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 1:2300 W ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-1638
Mailing Address - Country:US
Mailing Address - Phone:214-942-8999
Mailing Address - Fax:214-331-7273
Practice Address - Street 1:2300 W ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-1638
Practice Address - Country:US
Practice Address - Phone:214-942-8999
Practice Address - Fax:214-331-7273
Is Sole Proprietor?:No
Enumeration Date:2017-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13655111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor