Provider Demographics
NPI:1720524069
Name:CHANDRA, ANISH (DC)
Entity Type:Individual
Prefix:
First Name:ANISH
Middle Name:
Last Name:CHANDRA
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 1:7 DISTRICT DR
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2698
Mailing Address - Country:US
Mailing Address - Phone:909-816-0831
Mailing Address - Fax:
Practice Address - Street 1:7 DISTRICT DR
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-2698
Practice Address - Country:US
Practice Address - Phone:909-816-0831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31100111N00000X
CA136945111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor