Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | X002924-1 | NY |
NPI | 1689764680 |
---|---|
Provider Name | Dr. Dennis Anderson |
First Address | Hudson, NY 12534-2626 |
Second Address | Hudson, NY 12534-2626 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T78526 | (02) | NY |