Healthcare Provider Details

I. General information

NPI: 1619175288
Provider Name (Legal Business Name): RUSSELL N ANDERSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 12/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20825 SOUTH ST SUITE A
TEHACHAPI CA
93561-6438
US

IV. Provider business mailing address

20825 SOUTH ST SUITE A
TEHACHAPI CA
93561-6438
US

V. Phone/Fax

Practice location:
  • Phone: 661-205-5373
  • Fax: 661-823-7483
Mailing address:
  • Phone: 661-205-5373
  • Fax: 661-823-7483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number20106
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberB-866
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: