Provider Demographics
NPI:1083826986
Name:ANDERLA, MICHAEL JOSEPH (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:ANDERLA
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 17TH ST SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-6367
Mailing Address - Country:US
Mailing Address - Phone:253-735-0144
Mailing Address - Fax:253-876-9571
Practice Address - Street 1:1425 17TH ST SE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-6367
Practice Address - Country:US
Practice Address - Phone:253-735-0144
Practice Address - Fax:253-876-9571
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4903111N00000X
WACH60069981111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
350003903Medicare PIN