Provider Demographics
NPI:1922054147
Name:ANDERSON, ERIC W (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:W
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 1:11527 MACON ST
Mailing Address - Street 2:
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80640-9295
Mailing Address - Country:US
Mailing Address - Phone:303-847-3458
Mailing Address - Fax:
Practice Address - Street 1:540 E BRIDGE ST STE B
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-2171
Practice Address - Country:US
Practice Address - Phone:303-847-3458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5227111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC477898Medicare ID - Type Unspecified
COU92446Medicare UPIN