Provider Demographics
NPI:1851314801
Name:ANDERSON, RICK ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:RICK
Middle Name:ALAN
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 1:700 W VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-3744
Mailing Address - Country:US
Mailing Address - Phone:252-527-2800
Mailing Address - Fax:252-527-2532
Practice Address - Street 1:700 W VERNON AVE
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-3744
Practice Address - Country:US
Practice Address - Phone:252-527-2800
Practice Address - Fax:252-527-2532
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1688111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08204OtherBLUE CROSS/BLUE SHIELD
NC08204OtherBLUE CROSS/BLUE SHIELD