Provider Demographics
NPI:1205976859
Name:ANDERSON, JEFFERY R (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:R
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3609 OAKDALE RD STE 5
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357-0718
Mailing Address - Country:US
Mailing Address - Phone:209-551-8888
Mailing Address - Fax:209-551-0412
Practice Address - Street 1:3609 OAKDALE RD STE 5
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95357
Practice Address - Country:US
Practice Address - Phone:209-551-8888
Practice Address - Fax:209-551-0412
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23623111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA23623OtherCA STATE LIC NUMBER