Provider Demographics
NPI:1932287596
Name:ANDERSON, MATTHEW B (DC, PC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:B
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DC, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 WEST MOORPOINT DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-2810
Mailing Address - Country:US
Mailing Address - Phone:702-327-2495
Mailing Address - Fax:
Practice Address - Street 1:2590 NATURE PARK DR STE 135
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-3187
Practice Address - Country:US
Practice Address - Phone:702-636-2843
Practice Address - Fax:702-726-9543
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB-443111NX0100X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVU61991Medicare UPIN
NVV34856Medicare PIN
NV34856Medicare ID - Type UnspecifiedMEDICARE IDENTIFICATION