Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | B-443 | NV |
N | 111NX0100X | Occupational Health | B-443 | NV |
NPI | 1932287596 |
---|---|
Provider Name | Matthew B. Anderson |
First Address | North Las Vegas, NV 89032-0228 |
Second Address | North Las Vegas, NV 89032-0228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 17/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U61991 | (02) | NV |