Provider Demographics
NPI:1962444950
Name:ANDERSEN, GARRET J (DC)
Entity Type:Individual
Prefix:MR
First Name:GARRET
Middle Name:J
Last Name:ANDERSEN
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 1:2700 W COAST HWY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4728
Mailing Address - Country:US
Mailing Address - Phone:949-646-8830
Mailing Address - Fax:949-646-6184
Practice Address - Street 1:2700 W COAST HWY
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4725
Practice Address - Country:US
Practice Address - Phone:949-646-8830
Practice Address - Fax:949-646-6184
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19038111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor