Provider Demographics
NPI:1619960853
Name:ANDERSON LIFE CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:ANDERSON LIFE CHIROPRACTIC P.C.
Other - Org Name:ANDERSON LIFE CHIROPRACTIC INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:720-316-2202
Mailing Address - Street 1:8400 E PRENTICE AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2912
Mailing Address - Country:US
Mailing Address - Phone:720-316-2202
Mailing Address - Fax:303-840-7073
Practice Address - Street 1:8400 E PRENTICE AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2912
Practice Address - Country:US
Practice Address - Phone:720-316-2202
Practice Address - Fax:303-840-7073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5387111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO486948Medicaid