Provider Demographics
NPI:1184832198
Name:ANDERSON CHIROPRACTIC CLINIC, P.A.
Entity Type:Organization
Organization Name:ANDERSON CHIROPRACTIC CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-674-8391
Mailing Address - Street 1:38786 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MN
Mailing Address - Zip Code:55056-6696
Mailing Address - Country:US
Mailing Address - Phone:651-674-8391
Mailing Address - Fax:651-674-8391
Practice Address - Street 1:38786 8TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056-6696
Practice Address - Country:US
Practice Address - Phone:651-674-8391
Practice Address - Fax:651-674-8391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2361111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN269827700Medicaid
MNT39441Medicare UPIN
MN269827700Medicaid