Provider Demographics
NPI:1174699896
Name:ANDERSON CHIROPRACTIC PC
Entity type:Organization
Organization Name:ANDERSON CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:W
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-883-3877
Mailing Address - Street 1:PO BOX 908
Mailing Address - Street 2:36 WEST MAIN ST
Mailing Address - City:BROADALBIN
Mailing Address - State:NY
Mailing Address - Zip Code:12025
Mailing Address - Country:US
Mailing Address - Phone:518-883-3877
Mailing Address - Fax:518-883-8178
Practice Address - Street 1:36 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:BROADALBIN
Practice Address - State:NY
Practice Address - Zip Code:12025
Practice Address - Country:US
Practice Address - Phone:518-883-3877
Practice Address - Fax:518-883-8178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007617111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY98L152OtherMVP
NYX66372OtherEMPIRE BC
NY10038278OtherCDPHP
NY930862OtherEMPIRE PLAN
NYX66372OtherEMPIRE BC
NY10038278OtherCDPHP