Provider Demographics
NPI:1659845493
Name:ANDERSON, CURTIS (DC)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:
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 1:1310 N MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:IL
Mailing Address - Zip Code:60548-1399
Mailing Address - Country:US
Mailing Address - Phone:815-758-0000
Mailing Address - Fax:815-758-0094
Practice Address - Street 1:1310 N MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:IL
Practice Address - Zip Code:60548-1399
Practice Address - Country:US
Practice Address - Phone:815-758-0000
Practice Address - Fax:815-758-0094
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018045547111N00000X
IL038013837111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor