Provider Demographics
NPI:1841218930
Name:ANDERSON, AARON DALE (DC)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:DALE
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 1:2851 PARK MARINA DR STE 100
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2800
Mailing Address - Country:US
Mailing Address - Phone:530-241-1872
Mailing Address - Fax:530-241-5072
Practice Address - Street 1:2851 PARK MARINA DR STE 100
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2800
Practice Address - Country:US
Practice Address - Phone:530-241-1872
Practice Address - Fax:530-241-5072
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16094111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0160940OtherBLUE SHIELD PROVIDER NUMB
CADC0160940Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER