Provider Demographics
NPI:1780743930
Name:ANDEN, DANA RAE (DC)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:RAE
Last Name:ANDEN
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 1:193 FINLEY RD
Mailing Address - Street 2:
Mailing Address - City:BELLE VERNON
Mailing Address - State:PA
Mailing Address - Zip Code:15012-3822
Mailing Address - Country:US
Mailing Address - Phone:724-930-8060
Mailing Address - Fax:724-930-8083
Practice Address - Street 1:193 FINLEY RD
Practice Address - Street 2:
Practice Address - City:BELLE VERNON
Practice Address - State:PA
Practice Address - Zip Code:15012-3822
Practice Address - Country:US
Practice Address - Phone:724-930-8060
Practice Address - Fax:724-930-8083
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006158L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016165810002Medicaid
PA894308OtherBLUE CROSS BLUE SHIELD
PA1041004OtherGATEWAY HEALTH PLAN
PA81942OtherUNISON HEALTH PLAN
PA1041004OtherGATEWAY HEALTH PLAN
PA894308Medicare ID - Type Unspecified