Provider Demographics
NPI:1700911609
Name:ANDERSON, JEFFERY HUGH (D C)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:HUGH
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10250 HIGHWAY 59 S
Mailing Address - Street 2:
Mailing Address - City:SHEPHERD
Mailing Address - State:TX
Mailing Address - Zip Code:77371-6911
Mailing Address - Country:US
Mailing Address - Phone:832-326-3426
Mailing Address - Fax:
Practice Address - Street 1:123 COLDSPRING SQUARE
Practice Address - Street 2:
Practice Address - City:COLDSPRING
Practice Address - State:TX
Practice Address - Zip Code:77331
Practice Address - Country:US
Practice Address - Phone:936-653-4499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2913111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT11950Medicare UPIN