Provider Demographics
NPI:1336470368
Name:ANDERSON, MICHAEL T (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
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 1:24W500 MAPLE AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6055
Mailing Address - Country:US
Mailing Address - Phone:630-428-4300
Mailing Address - Fax:630-428-4305
Practice Address - Street 1:24W500 MAPLE AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6055
Practice Address - Country:US
Practice Address - Phone:630-428-4300
Practice Address - Fax:630-428-4305
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011588111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor