Healthcare Provider Details

I. General information

NPI: 1629118476
Provider Name (Legal Business Name): PEGGY J ANDERSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 04/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 E BELL AVE
MC CONNELSVILLE OH
43756
US

IV. Provider business mailing address

290 E BELL AVE
MC CONNELSVILLE OH
43756
US

V. Phone/Fax

Practice location:
  • Phone: 740-962-5700
  • Fax: 740-962-6093
Mailing address:
  • Phone: 740-962-5700
  • Fax: 740-962-6093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2439
License Number StateOH

VIII. Authorized Official

Name: DR. NATHAN JOHN DOUDNA
Title or Position: ASSOCIATE CHIROPRACTOR
Credential: DC
Phone: 740-962-5700