Provider Demographics
NPI:1861474769
Name:ANDERSON, DAVID BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRIAN
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 1:2790 N MILITARY TRL
Mailing Address - Street 2:STE 1
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409
Mailing Address - Country:US
Mailing Address - Phone:561-683-4971
Mailing Address - Fax:561-478-4946
Practice Address - Street 1:2790 N MILITARY TRL
Practice Address - Street 2:STE 1
Practice Address - City:W PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409
Practice Address - Country:US
Practice Address - Phone:561-683-4971
Practice Address - Fax:561-478-4946
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006427111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
4481407OtherUNITED HEALTHCARE
22733OtherBLUE CROSS/BLUE SHIELD
350044666OtherMEDICARE RAILROAD
FL7057015OtherAETNA
FL070217000Medicaid
5899670OtherGHI
611357OtherACN NETWORK
22733OtherBLUE CROSS/BLUE SHIELD
611357OtherACN NETWORK