Provider Demographics
NPI:1518013085
Name:ANDERSON, RONALD L (DC)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10130 COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:PENN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95946-9466
Mailing Address - Country:US
Mailing Address - Phone:530-432-3323
Mailing Address - Fax:
Practice Address - Street 1:10130 COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:PENN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95946-9466
Practice Address - Country:US
Practice Address - Phone:530-432-3323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23731111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0237310Medicare ID - Type Unspecified