Provider Demographics
NPI:1760543607
Name:ANDERSON, WARREN RICE (DC)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:RICE
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 1:840 OAK GROVE RD
Mailing Address - Street 2:STE. B
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-3503
Mailing Address - Country:US
Mailing Address - Phone:925-676-4000
Mailing Address - Fax:925-676-4025
Practice Address - Street 1:840 OAK GROVE RD
Practice Address - Street 2:STE. B
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-3503
Practice Address - Country:US
Practice Address - Phone:925-676-4000
Practice Address - Fax:925-676-4025
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21633111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA68-0334017OtherFED TAX ID
CA350038299OtherRAILROAD MEDICARE
CA68-0334017OtherFED TAX ID