Provider Demographics
NPI:1396841771
Name:ANDERSON, CONNIE ELAINE (DC)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:ELAINE
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 1:3501 S STERLING
Mailing Address - Street 2:SUITE D
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64052
Mailing Address - Country:US
Mailing Address - Phone:816-461-8486
Mailing Address - Fax:
Practice Address - Street 1:3501 S STERLING
Practice Address - Street 2:SUITE D
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64052
Practice Address - Country:US
Practice Address - Phone:816-461-8486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004301111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
000C719Medicare ID - Type Unspecified