Provider Demographics
NPI:1316272636
Name:ANDERSON, DAVID PAUL (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:PAUL
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 1:10585 SCRIPPS POWAY PARKWAY
Mailing Address - Street 2:#C
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131
Mailing Address - Country:US
Mailing Address - Phone:858-549-1088
Mailing Address - Fax:
Practice Address - Street 1:10585 SCRIPPS POWAY PARKWAY
Practice Address - Street 2:#C
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131
Practice Address - Country:US
Practice Address - Phone:858-549-1088
Practice Address - Fax:858-430-2789
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20105111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor