Provider Demographics
NPI:1639461510
Name:ANDERSON, ROBERT M (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
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 1:6308 MONROVIA ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-2740
Mailing Address - Country:US
Mailing Address - Phone:913-631-8888
Mailing Address - Fax:913-962-1627
Practice Address - Street 1:6308 MONROVIA ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66216-2740
Practice Address - Country:US
Practice Address - Phone:913-631-8888
Practice Address - Fax:913-962-1627
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05043111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor