Provider Demographics
NPI:1558582593
Name:ANDERSON, J. STEPHEN (DC)
Entity Type:Individual
Prefix:DR
First Name:J.
Middle Name:STEPHEN
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 1:342 AUGUSTA RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WINSLOW
Mailing Address - State:ME
Mailing Address - Zip Code:04901-0788
Mailing Address - Country:US
Mailing Address - Phone:207-873-7814
Mailing Address - Fax:207-872-2392
Practice Address - Street 1:342 AUGUSTA RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WINSLOW
Practice Address - State:ME
Practice Address - Zip Code:04901-0788
Practice Address - Country:US
Practice Address - Phone:207-873-7814
Practice Address - Fax:207-872-2392
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR598111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME015256Medicare ID - Type Unspecified