Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC-24270 | CA |
NPI | 1003831884 |
---|---|
Provider Name | Dr. Gregg Charles Anderson |
First Address | Sacramento, CA 95821-5328 |
Second Address | Sacramento, CA 95821-5328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 08/07/2007 |