Healthcare Provider Details

I. General information

NPI: 1790792992
Provider Name (Legal Business Name): ALISHA DANYIEL ANDERSON DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 AIRPORT RD
BEAVER WV
25813-9596
US

IV. Provider business mailing address

385 AIRPORT RD
BEAVER WV
25813-9596
US

V. Phone/Fax

Practice location:
  • Phone: 304-256-1110
  • Fax: 304-256-2442
Mailing address:
  • Phone: 304-256-1110
  • Fax: 304-256-2442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number761
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: