Provider Demographics
NPI:1275866865
Name:ANDERSON, MARC DAVID (DC)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:DAVID
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 1:161 19TH ST S
Mailing Address - Street 2:SUITE #101
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-2153
Mailing Address - Country:US
Mailing Address - Phone:320-257-0360
Mailing Address - Fax:
Practice Address - Street 1:161 19TH ST S
Practice Address - Street 2:SUITE #101
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-2153
Practice Address - Country:US
Practice Address - Phone:320-257-0360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN886171100000X
MN5280111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist