Provider Demographics
NPI:1508440892
Name:ANDERSON, ANDY WILLIAM (DC)
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:WILLIAM
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 1:2220 HIGHWAY 44 W
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34453-3860
Mailing Address - Country:US
Mailing Address - Phone:352-340-5936
Mailing Address - Fax:
Practice Address - Street 1:2220 HIGHWAY 44 W
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34453-3860
Practice Address - Country:US
Practice Address - Phone:352-340-5936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13534111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor