Provider Demographics
NPI:1568476760
Name:ANDERSON, ALAN DENNIS (DC)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:DENNIS
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 1:8720 MAIN ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4946
Mailing Address - Country:US
Mailing Address - Phone:770-592-1909
Mailing Address - Fax:770-592-7303
Practice Address - Street 1:8720 MAIN ST
Practice Address - Street 2:SUITE 120
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-4946
Practice Address - Country:US
Practice Address - Phone:770-592-1909
Practice Address - Fax:770-592-7303
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5289111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU57594Medicare UPIN
GA35ZCDBRMedicare ID - Type Unspecified