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General NPI Number Information
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NPI Number | 1174681670
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Entity Type | Individual
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Provider Name | MARVIN G ANDERSON DC
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Gender | Male
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 66 1ST ST STE A
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City | GILROY
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State | CA
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Zip | 95020-5140
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Country | US
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Telephone | 408-842-4388
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Fax | 408-842-8686
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Provider Business Mailing Address
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Address Line | 66 1ST ST STE A
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City | GILROY
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State | CA
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Zip | 95020-5140
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Country | US
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Telephone | 408-842-4388
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Fax | 408-842-8686
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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 | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 21634
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License Number State | CA
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