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General NPI Number Information
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NPI Number | 1093803066
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Entity Type | Individual
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Provider Name | CHAD MICHAEL ANDERSON D.C.
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Gender | Male
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | 102 N. MAIN STREET - SUITE #3
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City | KENANSVILLE
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State | NC
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Zip | 28349
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Country | US
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Telephone | 910-296-0019
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 454
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City | KENANSVILLE
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State | NC
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Zip | 28349-0454
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Country | US
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Telephone | 910-296-0019
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3907
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License Number State | NC
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