Provider Demographics
NPI:1427410422
Name:ANDERSON CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:ANDERSON CHIROPRACTIC, INC
Other - Org Name:HODGES CHIROPRACTIC AND SPORTS MEDECINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-469-2276
Mailing Address - Street 1:PO BOX 7967
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-0374
Mailing Address - Country:US
Mailing Address - Phone:541-469-2276
Mailing Address - Fax:541-469-0489
Practice Address - Street 1:411 MILL BEACH RD STE A
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9690
Practice Address - Country:US
Practice Address - Phone:541-469-2276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-28
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5716111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty