Pauline Marie Anderson, D.C., CCSP, I.D.E

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

20898 Issued in CA

Practice address

125 E. Sunnyoaks Ave
Ste 213
Campbell, CA 95008-6639

Phone

(408) 558-7998

Fax

(408) 864-2051

NPI assigned

Jul 17, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Chiropractic

Education

Palmer College Chiropractic - West Sunnyvale, 1990

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343260800000",
    "number": "1396763470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 E. SUNNYOAKS AVE",
            "address_2": "STE 213",
            "city": "CAMPBELL",
            "state": "CA",
            "postal_code": "950086639",
            "telephone_number": "408-558-7998",
            "fax_number": "408-864-2051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 E. SUNNYOAKS AVE",
            "address_2": "STE 213",
            "city": "CAMPBELL",
            "state": "CA",
            "postal_code": "950086639",
            "telephone_number": "408-558-7998",
            "fax_number": "408-864-2051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "PAULINE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "D.C., CCSP, I.D.E",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-17",
        "last_updated": "2012-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "CA",
            "license": "20898",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sports Physician Chiropractor in Campbell, CA
• Providers in Campbell, CA by specialty
• Sports Physician Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.