Provider Demographics
NPI:1093768335
Name:ANDERSON, KEVIN L (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:L
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 1:1227 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 WEST OAK STREET
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
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001080A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor