Provider Demographics
NPI:1700078102
Name:ANDERSON, BRIAN D (DC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
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 1:47 MAPLE ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-2571
Mailing Address - Country:US
Mailing Address - Phone:973-839-1003
Mailing Address - Fax:973-839-3653
Practice Address - Street 1:47 MAPLE ST STE 103
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2571
Practice Address - Country:US
Practice Address - Phone:973-839-1003
Practice Address - Fax:973-839-3653
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00656700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor