Provider Demographics
NPI:1558495093
Name:ANDERSON, JEREMY JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:JAMES
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 1:1123 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-4158
Mailing Address - Country:US
Mailing Address - Phone:509-837-2222
Mailing Address - Fax:509-232-3336
Practice Address - Street 1:1123 W COURT ST
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-4158
Practice Address - Country:US
Practice Address - Phone:509-837-2222
Practice Address - Fax:509-232-3336
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6445521-1202111N00000X
WACH00034761111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
8865835Medicare PIN