Provider Demographics
NPI:1740287150
Name:ANDERSEN, DARCY ANNE (DC)
Entity type:Individual
Prefix:
First Name:DARCY
Middle Name:ANNE
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-5937
Mailing Address - Country:US
Mailing Address - Phone:717-792-1799
Mailing Address - Fax:717-793-9200
Practice Address - Street 1:4305 W MARKET ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-5937
Practice Address - Country:US
Practice Address - Phone:717-792-1799
Practice Address - Fax:717-793-9200
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004106L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012655570002Medicaid
PA99682OtherMED PLUS
PA1145892OtherAMERIHEALTH/MERCY
PA611484Medicare ID - Type Unspecified
PA0012655570002Medicaid