Healthcare Provider Details

I. General information

NPI: 1992867253
Provider Name (Legal Business Name): PEGGY J ANDERSON D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 01/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 E BELL AVE
MC CONNELSVILLE OH
43756-1339
US

IV. Provider business mailing address

209 E BELL AVE
MC CONNELSVILLE OH
43756-1339
US

V. Phone/Fax

Practice location:
  • Phone: 740-962-5700
  • Fax: 740-962-6229
Mailing address:
  • Phone: 740-962-5700
  • Fax: 740-962-6229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1789
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: