Provider Demographics
NPI:1285814723
Name:ANDERSON CHIROPRACTIC PC
Entity Type:Organization
Organization Name:ANDERSON CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-721-9996
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT602261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center