Provider Demographics
NPI:1033108378
Name:ANDERSON, JAMES N (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:N
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 1:296 W SUNSET AVE
Mailing Address - Street 2:#15
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8330
Mailing Address - Country:US
Mailing Address - Phone:208-667-3000
Mailing Address - Fax:
Practice Address - Street 1:296 W SUNSET AVE
Practice Address - Street 2:#15
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8330
Practice Address - Country:US
Practice Address - Phone:208-667-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA568111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1672515Medicare PIN