Provider Demographics
NPI:1710958707
Name:ANDERSON, JEFFERY A (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:A
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 1:614 BUDDY HOLLY PLACE
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50428-1364
Mailing Address - Country:US
Mailing Address - Phone:641-357-8659
Mailing Address - Fax:641-357-0799
Practice Address - Street 1:614 BUDDY HOLLY PLACE
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:IA
Practice Address - Zip Code:50428-1364
Practice Address - Country:US
Practice Address - Phone:641-357-8659
Practice Address - Fax:641-357-0799
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA5539111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0099051Medicaid
04999OtherBLUE CROSS BLUE SHIELD
21297OtherMIDLAND CHOICE
IA0099051Medicaid
U20651Medicare UPIN