Provider Demographics
NPI:1215000898
Name:ANDERSON, MICHAEL D (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
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 1:517 N CARRIER PKWY
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-5484
Mailing Address - Country:US
Mailing Address - Phone:214-460-0644
Mailing Address - Fax:972-642-5183
Practice Address - Street 1:517 N CARRIER PKWY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-5484
Practice Address - Country:US
Practice Address - Phone:214-460-0644
Practice Address - Fax:972-642-5183
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZE0500X, 246ZE0600X
TX8788111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEG
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB101221Medicare PIN
TXTXB101205Medicare PIN