Provider Demographics
NPI:1912033861
Name:ANDERSON, DAVID HAROLD (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HAROLD
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 1:3209 W SHAW AVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3226
Mailing Address - Country:US
Mailing Address - Phone:559-224-4977
Mailing Address - Fax:559-224-4980
Practice Address - Street 1:3209 W SHAW AVE
Practice Address - Street 2:SUITE 114
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3226
Practice Address - Country:US
Practice Address - Phone:559-224-4977
Practice Address - Fax:559-224-4980
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21217111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0212170Medicaid
CADC021217Medicare ID - Type Unspecified
CADC0212170Medicaid