Healthcare Provider Details

I. General information

NPI: 1144337916
Provider Name (Legal Business Name): PETER WILLIAM ANDERSON DC, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 RYAN DR SE
SALEM OR
97301-5057
US

IV. Provider business mailing address

723 NE EVANS ST
MCMINNVILLE OR
97128-3925
US

V. Phone/Fax

Practice location:
  • Phone: 503-540-9999
  • Fax: 503-540-3105
Mailing address:
  • Phone: 503-434-9002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number197354
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2958
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: