Provider Demographics
NPI:1194711663
Name:ANDERSON, ERIC P (DC)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:P
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 1:8210 UNIVERSITY EXEC PARK DR
Mailing Address - Street 2:STE 110
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-1329
Mailing Address - Country:US
Mailing Address - Phone:704-549-1181
Mailing Address - Fax:704-549-1145
Practice Address - Street 1:8310 UNIVERSITY EXEC PARK DR
Practice Address - Street 2:SUITE 525
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3383
Practice Address - Country:US
Practice Address - Phone:704-549-1181
Practice Address - Fax:704-549-1145
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2310111N00000X
NC2628111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890835MMedicaid
2452827Medicare ID - Type Unspecified
NC890835MMedicaid