Provider Demographics
NPI:1427215482
Name:ANDERSON, ROBERT ANDREW (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ANDREW
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5023 W 120TH AVE
Mailing Address - Street 2:324
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020
Mailing Address - Country:US
Mailing Address - Phone:720-956-0156
Mailing Address - Fax:303-466-8581
Practice Address - Street 1:331 14TH ST
Practice Address - Street 2:208
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-5040
Practice Address - Country:US
Practice Address - Phone:720-956-0156
Practice Address - Fax:303-466-8581
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1472111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor