Provider Demographics
NPI:1700985728
Name:ANDERSON CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:ANDERSON CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-256-1110
Mailing Address - Street 1:385 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:WV
Mailing Address - Zip Code:25813-9596
Mailing Address - Country:US
Mailing Address - Phone:304-256-1110
Mailing Address - Fax:304-256-2442
Practice Address - Street 1:385 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:WV
Practice Address - Zip Code:25813-9596
Practice Address - Country:US
Practice Address - Phone:304-256-1110
Practice Address - Fax:304-256-2442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV761111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001721659OtherBLUE CROSS
WV0209220000Medicaid
WV001721659OtherBLUE CROSS
WV4086423Medicare ID - Type Unspecified