Provider Demographics
NPI:1386950103
Name:ANDERSON, JEFFREY (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
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 1:7553 COUNTY ROAD 25
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-9151
Mailing Address - Country:US
Mailing Address - Phone:970-310-6518
Mailing Address - Fax:
Practice Address - Street 1:1010 UNIVERSITY AVE
Practice Address - Street 2:SUITE C-201
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3398
Practice Address - Country:US
Practice Address - Phone:619-295-9791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31749111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor