MEDICARE: DR. ELIDGE DEMETE 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	34751	CA

General Provider Information

NPI Number	:	1679105746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIDGE DEMETE ANDERSON DC

Provider Business Mailing Address
First Line	:	PO BOX 7101
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-0101
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	272 E 69TH WAY
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-1240
Country	:	US
Telephone Number	:	757-282-8111
Fax Number	:

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

Provider Enumeration Date	:	02/06/2020
Last Update Date	:	02/06/2020

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