Provider Demographics
NPI:1154178085
Name:ANDERSON, VINCENT ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:ANTHONY
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 1:351 SAN TROPEZ CT
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-4433
Mailing Address - Country:US
Mailing Address - Phone:480-793-0652
Mailing Address - Fax:
Practice Address - Street 1:17811 SKY PARK CIR STE E
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6109
Practice Address - Country:US
Practice Address - Phone:480-793-0652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35216111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty