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General NPI Number Information
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NPI Number | 1619734696
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Entity Type | Individual
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Provider Name | JOSH ANDERSON
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Gender | Male
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Dates
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Enumeration Date | 03/05/2024
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Last Update Date | 03/05/2024
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Provider Practice Location Address
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Address Line | 5714 FOLSOM BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95819-4608
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Country | US
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Telephone | 916-400-4524
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 53RD ST
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City | SACRAMENTO
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State | CA
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Zip | 95819-4819
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Country | US
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Telephone | 402-680-4231
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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 | 36467
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License Number State | CA
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