Provider Demographics
NPI:1700805256
Name:ANDERSON, COREY ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:ROBERT
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 1:223 E 14TH ST
Mailing Address - Street 2:SUITE 50
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-3200
Mailing Address - Country:US
Mailing Address - Phone:402-462-9999
Mailing Address - Fax:402-462-9545
Practice Address - Street 1:223 E 14TH ST
Practice Address - Street 2:SUITE 50
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-3200
Practice Address - Country:US
Practice Address - Phone:402-462-9999
Practice Address - Fax:402-462-9545
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1246111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE273288Medicare ID - Type UnspecifiedMEDICARE