Provider Demographics
NPI:1487628830
Name:ANDERSON, JOHN C (DC, DABCO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DC, DABCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CROPWELL DR
Mailing Address - Street 2:
Mailing Address - City:PELL CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35128-7552
Mailing Address - Country:US
Mailing Address - Phone:205-338-4445
Mailing Address - Fax:205-338-4452
Practice Address - Street 1:12 CROPWELL DR
Practice Address - Street 2:
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35128-7552
Practice Address - Country:US
Practice Address - Phone:205-338-4445
Practice Address - Fax:205-338-4452
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1365111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT77196Medicare UPIN