Provider Demographics
NPI:1588798029
Name:ANDERSON, JOHN A (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
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 1:8474 SCOTTISH DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-2143
Mailing Address - Country:US
Mailing Address - Phone:801-278-7444
Mailing Address - Fax:801-272-6920
Practice Address - Street 1:6069 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84121-1375
Practice Address - Country:US
Practice Address - Phone:801-278-7444
Practice Address - Fax:801-272-6920
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT280271-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor