Provider Demographics
NPI:1558360362
Name:ANDERSON, JAY DOYLE (DC)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:DOYLE
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 1:642 KIRBY LN STE 103
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-5753
Mailing Address - Country:US
Mailing Address - Phone:801-798-6558
Mailing Address - Fax:801-798-3690
Practice Address - Street 1:642 KIRBY LN STE 103
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-5753
Practice Address - Country:US
Practice Address - Phone:801-798-6558
Practice Address - Fax:801-798-3690
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2022-12-02
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
UT942708911202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U18847Medicare UPIN