Healthcare Provider Details

I. General information

NPI: 1487628830
Provider Name (Legal Business Name): JOHN C ANDERSON D.C., DABCO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 CROPWELL DR
PELL CITY AL
35128-7552
US

IV. Provider business mailing address

12 CROPWELL DR
PELL CITY AL
35128-7552
US

V. Phone/Fax

Practice location:
  • Phone: 205-338-4445
  • Fax: 205-338-4452
Mailing address:
  • Phone: 205-338-4445
  • Fax: 205-338-4452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1365
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: