Provider Demographics
NPI:1538138136
Name:ANDERSON, CRAIG NORMAN (DC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:NORMAN
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 1:316 WESTERN AVE
Mailing Address - Street 2:STE. 1
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-3672
Mailing Address - Country:US
Mailing Address - Phone:802-254-4641
Mailing Address - Fax:802-254-4641
Practice Address - Street 1:316 WESTERN AVE
Practice Address - Street 2:STE. 1
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-3672
Practice Address - Country:US
Practice Address - Phone:802-254-4641
Practice Address - Fax:802-254-4641
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT645111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTT87381Medicare UPIN
VTANVT8766Medicare ID - Type Unspecified