Provider Demographics
NPI:1891970109
Name:JERI L ANDERSON PROF CHIROPRACTIC CORP
Entity Type:Organization
Organization Name:JERI L ANDERSON PROF CHIROPRACTIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERI
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-368-1600
Mailing Address - Street 1:9500 MICRON AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2617
Mailing Address - Country:US
Mailing Address - Phone:916-368-1600
Mailing Address - Fax:
Practice Address - Street 1:9500 MICRON AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2617
Practice Address - Country:US
Practice Address - Phone:916-368-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18303111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1CZZZ25198ZMedicare PIN
CA1CZZZ25198ZMedicare UPIN