Provider Demographics
NPI:1598068314
Name:ANDERSON, SETH ERIK (DC)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:ERIK
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 1:101 N 4TH ST
Mailing Address - Street 2:STE A
Mailing Address - City:OREGON
Mailing Address - State:IL
Mailing Address - Zip Code:61061-1430
Mailing Address - Country:US
Mailing Address - Phone:815-881-8191
Mailing Address - Fax:815-881-8193
Practice Address - Street 1:101 N 4TH ST
Practice Address - Street 2:STE A
Practice Address - City:OREGON
Practice Address - State:IL
Practice Address - Zip Code:61061-1430
Practice Address - Country:US
Practice Address - Phone:815-881-8191
Practice Address - Fax:815-881-8193
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011805111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09821954OtherBCBS
IL038011805Medicaid
12386345OtherCAQH
IL09821954OtherBCBS