Provider Demographics
NPI:1104907336
Name:ANDERSON, JOHN M (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
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:PO BOX 223
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914
Mailing Address - Country:US
Mailing Address - Phone:215-997-1913
Mailing Address - Fax:
Practice Address - Street 1:350 N. MAIN ST
Practice Address - Street 2:STE 201
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914
Practice Address - Country:US
Practice Address - Phone:215-997-4545
Practice Address - Fax:215-997-4547
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002894L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0023221000Medicare UPIN
PA232830980Medicare UPIN
PA34259Medicare ID - Type Unspecified
PA2447656Medicare UPIN
PA000383336Medicare UPIN
PA4461918Medicare UPIN
PA0310250000Medicare UPIN