MEDICARE: PORCHA ANDERSON DC

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
1	111N00000X	Chiropractor	13655	TX

General Provider Information

NPI Number	:	1417463498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PORCHA ANDERSON DC

Provider Business Mailing Address
First Line	:	2300 W ILLINOIS AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75224-1638
Country	:	US
Telephone Number	:	214-942-8999
Fax Number	:	214-331-7273

Provider Business Practice Location Address
First Line	:	2300 W ILLINOIS AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75224-1638
Country	:	US
Telephone Number	:	214-942-8999
Fax Number	:	214-331-7273

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2017
Last Update Date	:	12/28/2017

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Directions to “ PORCHA ANDERSON DC” Practice Location

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