Provider Demographics
NPI:1710401435
Name:ANTHOFER, ANDREW JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JOHN
Last Name:ANTHOFER
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 1:458 NE DELAWARE AVE APT 330
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-6603
Mailing Address - Country:US
Mailing Address - Phone:712-721-0516
Mailing Address - Fax:
Practice Address - Street 1:458 NE DELAWARE AVE # 330
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-6603
Practice Address - Country:US
Practice Address - Phone:712-210-5161
Practice Address - Fax:712-210-5161
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA088602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor