Provider Demographics
NPI:1326312463
Name:ANDERSON, CARRI E (DC)
Entity Type:Individual
Prefix:DR
First Name:CARRI
Middle Name:E
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N 4TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:OREGON
Mailing Address - State:IL
Mailing Address - Zip Code:61061-1430
Mailing Address - Country:US
Mailing Address - Phone:815-440-5120
Mailing Address - Fax:
Practice Address - Street 1:101 N 4TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:OREGON
Practice Address - State:IL
Practice Address - Zip Code:61061-1430
Practice Address - Country:US
Practice Address - Phone:815-440-5120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012124111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09821954OtherBCBS