Provider Demographics
NPI:1013194778
Name:KEVIN L ANDERSON DC PC
Entity Type:Organization
Organization Name:KEVIN L ANDERSON DC PC
Other - Org Name:ANDERSON CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-873-1000
Mailing Address - Street 1:1227 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-1262
Mailing Address - Country:US
Mailing Address - Phone:317-873-1000
Mailing Address - Fax:317-873-0401
Practice Address - Street 1:1227 W OAK ST
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-1262
Practice Address - Country:US
Practice Address - Phone:317-873-1000
Practice Address - Fax:317-873-0401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN51000104A261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN092170Medicaid