Provider Demographics
NPI:1831327220
Name:ANDERSON CHIROPRACTIC
Entity type:Organization
Organization Name:ANDERSON CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:B
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PC
Authorized Official - Phone:702-657-8000
Mailing Address - Street 1:6485 N DECATUR BLVD
Mailing Address - Street 2:STE. 130
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-2988
Mailing Address - Country:US
Mailing Address - Phone:702-657-8000
Mailing Address - Fax:702-657-8854
Practice Address - Street 1:6485 N DECATUR BLVD
Practice Address - Street 2:STE. 130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-2988
Practice Address - Country:US
Practice Address - Phone:702-657-8000
Practice Address - Fax:702-657-8854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00443305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV34856Medicare PIN