Provider Demographics
NPI:1154782035
Name:ANDERSON, RICARDO (DC)
Entity type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:
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 1:7830 W LAWRNCE AVE
Mailing Address - Street 2:
Mailing Address - City:NORRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60706-3267
Mailing Address - Country:US
Mailing Address - Phone:708-457-8000
Mailing Address - Fax:708-457-1333
Practice Address - Street 1:7830 W LAWRNCE AVE
Practice Address - Street 2:
Practice Address - City:NORRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60706-3267
Practice Address - Country:US
Practice Address - Phone:708-457-8000
Practice Address - Fax:708-457-1333
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-18
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012934111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor