Provider Demographics
NPI:1558606129
Name:ANDERSON FAMILY CHIROPRACTIC CENTER, PA
Entity Type:Organization
Organization Name:ANDERSON FAMILY CHIROPRACTIC CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DC
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-527-2800
Mailing Address - Street 1:700 W VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-3744
Mailing Address - Country:US
Mailing Address - Phone:252-527-2800
Mailing Address - Fax:252-527-2532
Practice Address - Street 1:700 W VERNON AVE
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-3744
Practice Address - Country:US
Practice Address - Phone:252-527-2800
Practice Address - Fax:252-527-2532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1688111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908204Medicaid
NC8908204Medicaid