Provider Demographics
NPI:1558356675
Name:ANDERSON, DANA WARREN (DC)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:WARREN
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 1:2201 E HILL RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-5057
Mailing Address - Country:US
Mailing Address - Phone:810-238-9066
Mailing Address - Fax:810-238-9139
Practice Address - Street 1:1174 W HILL RD
Practice Address - Street 2:SUITE 2
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-4776
Practice Address - Country:US
Practice Address - Phone:810-238-9066
Practice Address - Fax:810-238-9139
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2019-12-05
Deactivation Date:2006-04-13
Deactivation Code:
Reactivation Date:2006-04-13
Provider Licenses
StateLicense IDTaxonomies
MI2301008894111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950B513420OtherBLUE CROSS BLUE SHIELD