Provider Demographics
NPI:1407932429
Name:ANDERSON, DONALD ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ANDREW
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 1:801 NE 4TH ST.
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-3106
Mailing Address - Country:US
Mailing Address - Phone:218-326-1732
Mailing Address - Fax:218-327-3415
Practice Address - Street 1:801 NE 4TH ST.
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-3106
Practice Address - Country:US
Practice Address - Phone:218-326-1732
Practice Address - Fax:218-327-3415
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3641111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0456OtherHSM
MN350054233OtherRAIL ROAD MEDICARE
MN4410149-00OtherIM CARE
MN68987OtherUNICARE
MN44-87267OtherMEDICA
MN4410149-00OtherMN DEPT. OF HUMAN SERVICES
MN56Q93ITOtherBLUE CROSS BLUE SHIELD OF MN
MN56Q93ITOtherCOMPREHENSIVE CARE SERVICES
MN68987OtherHUMANA
MN56Q93ITOtherBLUE CROSS BLUE SHIELD BLUE PLUS
MN56Q93ITOtherCOMPREHENSIVE CARE SERVICES