Provider Demographics
NPI:1639192610
Name:ANDERSON, MICHAEL PATRICK (DC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:PATRICK
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 1:2133 HWY 317
Mailing Address - Street 2:SUITE 12-318
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2649
Mailing Address - Country:US
Mailing Address - Phone:877-704-1761
Mailing Address - Fax:678-730-0280
Practice Address - Street 1:3441 LAWRENCEVILLE SUWANEE RD.
Practice Address - Street 2:SUITE C
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024
Practice Address - Country:US
Practice Address - Phone:877-704-1761
Practice Address - Fax:678-730-0280
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007341111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP1288OtherGROUP NUMBER
GAGRP1288OtherGROUP NUMBER
GA35ZCJJJMedicare ID - Type Unspecified