Healthcare Provider Details

I. General information

NPI: 1174699896
Provider Name (Legal Business Name): ANDERSON CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 WEST MAIN ST
BROADALBIN NY
12025
US

IV. Provider business mailing address

PO BOX 908 36 WEST MAIN ST
BROADALBIN NY
12025
US

V. Phone/Fax

Practice location:
  • Phone: 518-883-3877
  • Fax: 518-883-8178
Mailing address:
  • Phone: 518-883-3877
  • Fax: 518-883-8178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX007617
License Number StateNY

VIII. Authorized Official

Name: MR. CRAIG W ANDERSON
Title or Position: DOCTOR OWNER
Credential: DC
Phone: 518-883-3877