Provider Demographics
NPI:1487853602
Name:ANDERSON, JORY LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:JORY
Middle Name:LYNN
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 1:823 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-2347
Mailing Address - Country:US
Mailing Address - Phone:509-839-5555
Mailing Address - Fax:509-839-9875
Practice Address - Street 1:823 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-2347
Practice Address - Country:US
Practice Address - Phone:509-839-5555
Practice Address - Fax:509-839-9875
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034054111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
8858539OtherMEDICARE GROUP NUMBER
U88196Medicare UPIN
8858539OtherMEDICARE GROUP NUMBER