Provider Demographics
NPI:1063623957
Name:ANDERSON, ROBERT J (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3049 UALENA ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-1942
Mailing Address - Country:US
Mailing Address - Phone:808-834-8662
Mailing Address - Fax:808-836-7627
Practice Address - Street 1:3049 UALENA ST
Practice Address - Street 2:SUITE 104
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1942
Practice Address - Country:US
Practice Address - Phone:808-834-8662
Practice Address - Fax:808-836-7627
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007543-L111N00000X
HI858111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA034413Medicare ID - Type Unspecified