Provider Demographics
NPI:1891734380
Name:ANDERSON, MATTHEW JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JAMES
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 1:10607 FRANCE AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-3539
Mailing Address - Country:US
Mailing Address - Phone:952-881-5703
Mailing Address - Fax:952-881-6871
Practice Address - Street 1:10607 FRANCE AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-3539
Practice Address - Country:US
Practice Address - Phone:952-881-5703
Practice Address - Fax:952-881-6871
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2928111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN258826900Medicaid
MN258826900Medicaid
MN350002081Medicare ID - Type Unspecified