Provider Demographics
NPI:1497920193
Name:DR. KENDALL ANDERSON, P.C.
Entity Type:Organization
Organization Name:DR. KENDALL ANDERSON, P.C.
Other - Org Name:ANDERSON CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-342-7110
Mailing Address - Street 1:3618 CANYON LAKE DRIVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-3129
Mailing Address - Country:US
Mailing Address - Phone:605-342-7110
Mailing Address - Fax:
Practice Address - Street 1:3618 CANYON LAKE DRIVE
Practice Address - Street 2:SUITE 114
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-3129
Practice Address - Country:US
Practice Address - Phone:605-342-7110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD695261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS86544Medicare PIN