Provider Demographics
NPI:1285763110
Name:ANDERSON, PATRICK J (DC)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:1099 MERCHANTS DR STE A
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-3005
Mailing Address - Country:US
Mailing Address - Phone:770-443-0787
Mailing Address - Fax:770-443-3890
Practice Address - Street 1:1099 MERCHANTS DR STE A
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-3005
Practice Address - Country:US
Practice Address - Phone:770-443-0787
Practice Address - Fax:770-443-3890
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006976111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor