Provider Demographics
NPI:1134278682
Name:ANDERSON, MICHAEL ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALAN
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 1:3031 S RUSSELL ST
Mailing Address - Street 2:STE 2
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-8540
Mailing Address - Country:US
Mailing Address - Phone:406-721-9996
Mailing Address - Fax:406-327-6702
Practice Address - Street 1:3031 S RUSSELL ST
Practice Address - Street 2:STE 2
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-8540
Practice Address - Country:US
Practice Address - Phone:406-721-9996
Practice Address - Fax:406-327-6702
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT602111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT40150OtherBLUE CROSS BLUE SHIELD MT