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General NPI Number Information
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NPI Number | 1164823399
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Entity Type | Organization
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Legal Business Name | BRIAN ANDERSON, DC, LLC
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Dates
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Enumeration Date | 09/08/2014
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Last Update Date | 10/29/2015
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Provider Practice Location Address
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Address Line | 1941 BISHOP LN SUITE 508
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City | LOUISVILLE
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State | KY
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Zip | 40218-1922
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Country | US
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Telephone | 502-451-0484
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Fax | 502-451-0778
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Provider Business Mailing Address
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Address Line | 1941 BISHOP LN SUITE 508
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City | LOUISVILLE
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State | KY
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Zip | 40218-1922
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Country | US
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Telephone | 502-451-0484
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Fax | 502-451-0778
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRIAN DAVID ANDERSON
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Credential | D.C.
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Telephone | 502-451-0484
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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 | 4679
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License Number State | KY
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