Provider Demographics
NPI:1144215518
Name:ANDERSON, THOMAS ALDEN (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ALDEN
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 1:8088 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-2450
Mailing Address - Country:US
Mailing Address - Phone:515-252-7070
Mailing Address - Fax:515-252-7670
Practice Address - Street 1:8088 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-2450
Practice Address - Country:US
Practice Address - Phone:515-252-7070
Practice Address - Fax:515-252-7670
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0472860Medicaid
IAI16375Medicare ID - Type UnspecifiedGROUP PROVIDER #
IAI16374Medicare ID - Type UnspecifiedINDIV. MEDICARE PROV #
IA0472860Medicaid