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General NPI Number Information
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NPI Number | 1558605980
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Entity Type | Organization
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Legal Business Name | SAN PEDRO PAIN AND DISC INSTITUTE INC
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Dates
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Enumeration Date | 11/26/2012
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Last Update Date | 08/08/2013
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Provider Practice Location Address
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Address Line | 757 W 9TH ST
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City | SAN PEDRO
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State | CA
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Zip | 90731-3601
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Country | US
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Telephone | 310-856-7999
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Fax | 310-856-7771
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Provider Business Mailing Address
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Address Line | 757 W 9TH ST
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City | SAN PEDRO
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State | CA
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Zip | 90731-3601
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Country | US
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Telephone | 310-856-7999
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Fax | 310-856-7771
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GREG ANDERSON
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Credential | M.D.
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Telephone | 310-856-7999
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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 | DC24671
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | G33010
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License Number State | CA
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