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General NPI Number Information
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NPI Number | 1568676898
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Entity Type | Organization
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Legal Business Name | GREG ANDERSON DC PC
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 07/25/2008
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Provider Practice Location Address
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Address Line | 7111 SOUTHEASTERN AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46239-1207
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Country | US
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Telephone | 317-375-1664
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Fax | 317-352-1292
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Provider Business Mailing Address
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Address Line | 7111 SOUTHEASTERN AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46239-1207
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Country | US
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Telephone | 317-375-1664
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Fax | 317-352-1292
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN GREGORY ANDERSON
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Credential | DC
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Telephone | 317-375-1664
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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 | 800759
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License Number State | IN
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