Provider Demographics
NPI:1902849037
Name:ANDERSON, MARK STEVEN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
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 1:5161 MAPLE DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:PLEASANT HILL
Mailing Address - State:IA
Mailing Address - Zip Code:50327-8454
Mailing Address - Country:US
Mailing Address - Phone:515-266-6090
Mailing Address - Fax:515-266-6150
Practice Address - Street 1:5161 MAPLE DR
Practice Address - Street 2:SUITE D
Practice Address - City:PLEASANT HILL
Practice Address - State:IA
Practice Address - Zip Code:50327-8454
Practice Address - Country:US
Practice Address - Phone:515-266-6090
Practice Address - Fax:515-266-6150
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06872111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0489021Medicaid
IA0489047Medicaid
IAV09048Medicare UPIN
IA0489047Medicaid
IAI17422Medicare PIN