Provider Demographics
NPI:1366540445
Name:ANDERSON, ROBERT DANA (DC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DANA
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 1:7103 W GRANDRIDGE BLVD
Mailing Address - Street 2:SUITE #B
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-6713
Mailing Address - Country:US
Mailing Address - Phone:509-783-7363
Mailing Address - Fax:509-783-0329
Practice Address - Street 1:7103 W GRANDRIDGE BLVD
Practice Address - Street 2:SUITE #B
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-6713
Practice Address - Country:US
Practice Address - Phone:509-783-7363
Practice Address - Fax:509-783-0329
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001583111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA17579OtherLABOR & INDUSTIRES