Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 21634 | CA |
NPI | 1174681670 |
---|---|
Provider Name | Mr. Marvin G Anderson |
First Address | Gilroy, CA 95020-5140 |
Second Address | Gilroy, CA 95020-5140 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC0216340 | (02) | CA |