Provider Demographics
NPI:1265521397
Name:ANDERSON FAMILY CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:ANDERSON FAMILY CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:P
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-549-1181
Mailing Address - Street 1:8310 UNIVERSITY EXEC PARK DR
Mailing Address - Street 2:SUITE 525
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3383
Mailing Address - Country:US
Mailing Address - Phone:704-549-1181
Mailing Address - Fax:704-549-1145
Practice Address - Street 1:8310 UNIVERSITY EXEC PARK DR
Practice Address - Street 2:SUITE 525
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3383
Practice Address - Country:US
Practice Address - Phone:704-549-1181
Practice Address - Fax:704-549-1145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2628111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890835MMedicaid