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NPI Code Detail

MEDICARE: PETER WILLIAM ANDERSON DC, PA-C

MEDICARE: PETER WILLIAM ANDERSON DC, PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant197354OR
2111N00000XChiropractor2958OR

General Provider Information

NPI Number : 1144337916
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER WILLIAM ANDERSON DC, PA-C
Provider Business Mailing Address
First Line : 723 NE EVANS ST
Second Line :
City : MCMINNVILLE
State : OR
Zip : 97128-3925
Country : US
Telephone Number : 503-434-9002
Fax Number :
Provider Business Practice Location Address
First Line : 3025 RYAN DR SE
Second Line :
City : SALEM
State : OR
Zip : 97301-5057
Country : US
Telephone Number : 503-540-9999
Fax Number : 503-540-3105
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2006
Last Update Date : 02/20/2024

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Directions to “ PETER WILLIAM ANDERSON DC, PA-C” Practice Location

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