Provider Demographics
NPI:1710158720
Name:ANDERBERG, JOSHUA (DC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:ANDERBERG
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 1:14665 MERCANTILE DR N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HUGO
Mailing Address - State:MN
Mailing Address - Zip Code:55038-4559
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14665 MERCANTILE DR N
Practice Address - Street 2:SUITE 100
Practice Address - City:HUGO
Practice Address - State:MN
Practice Address - Zip Code:55038-4559
Practice Address - Country:US
Practice Address - Phone:651-204-5533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4656111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCO4119OtherMEDICARE GROUP
MNCO4119OtherMEDICARE GROUP