Provider Demographics
NPI:1790792992
Name:ANDERSON, ALISHA DANYIEL (DC)
Entity Type:Individual
Prefix:MRS
First Name:ALISHA
Middle Name:DANYIEL
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:WV
Mailing Address - Zip Code:25813-9596
Mailing Address - Country:US
Mailing Address - Phone:304-256-1110
Mailing Address - Fax:304-256-2442
Practice Address - Street 1:385 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:WV
Practice Address - Zip Code:25813-9596
Practice Address - Country:US
Practice Address - Phone:304-256-1110
Practice Address - Fax:304-256-2442
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV761111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2201056000Medicaid
WV4086423Medicare ID - Type Unspecified
WV2201056000Medicaid