Provider Demographics
NPI:1407862832
Name:ANDERSON, DAVID CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHARLES
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 1:4 13TH AVE N
Mailing Address - Street 2:
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387-1036
Mailing Address - Country:US
Mailing Address - Phone:320-252-8383
Mailing Address - Fax:320-252-9028
Practice Address - Street 1:4 13TH AVE N
Practice Address - Street 2:
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-1036
Practice Address - Country:US
Practice Address - Phone:320-252-8383
Practice Address - Fax:320-252-9028
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3223111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN155216300Medicaid
MN6C338ANOtherBCBS
MN6C338ANOtherBCBS
350001679Medicare ID - Type UnspecifiedSTANDARD MEDICARE
350041524Medicare ID - Type UnspecifiedRAILROAD MEDICARE