Provider Demographics
NPI:1285625491
Name:ANDERSON, DAVID DWAIN (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DWAIN
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 1:1101 WATERS EDGE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-1474
Mailing Address - Country:US
Mailing Address - Phone:817-579-6400
Mailing Address - Fax:817-579-8176
Practice Address - Street 1:1101 WATERS EDGE DR
Practice Address - Street 2:STE 100
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-1474
Practice Address - Country:US
Practice Address - Phone:817-579-6400
Practice Address - Fax:817-579-8176
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6953111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U63546Medicare UPIN
TX605539Medicare ID - Type Unspecified