Provider Demographics
NPI:1033629316
Name:ANDERSON, DARIN JAMES
Entity Type:Individual
Prefix:
First Name:DARIN
Middle Name:JAMES
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8654 310TH LN NE
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MN
Mailing Address - Zip Code:55056-6516
Mailing Address - Country:US
Mailing Address - Phone:763-301-4722
Mailing Address - Fax:
Practice Address - Street 1:4 ENTERPRISE AVE NE
Practice Address - Street 2:
Practice Address - City:ISANTI
Practice Address - State:MN
Practice Address - Zip Code:55040-6813
Practice Address - Country:US
Practice Address - Phone:763-552-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist