MEDICARE: DR. CONSTANCE J ANDERSON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC22956	CA

General Provider Information

NPI Number	:	1104849637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CONSTANCE J ANDERSON D.C.

Provider Business Mailing Address
First Line	:	286 CHERRY AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-3946
Country	:	US
Telephone Number	:	562-434-0887
Fax Number	:	562-434-0668

Provider Business Practice Location Address
First Line	:	286 CHERRY AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-3946
Country	:	US
Telephone Number	:	562-434-0887
Fax Number	:	562-434-0668

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/08/2007

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