Provider Demographics
NPI:1922290220
Name:ANDERSON FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:ANDERSON FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-878-8312
Mailing Address - Street 1:PO BOX 254
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43566-0254
Mailing Address - Country:US
Mailing Address - Phone:419-878-8312
Mailing Address - Fax:419-878-8844
Practice Address - Street 1:751 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43566-1052
Practice Address - Country:US
Practice Address - Phone:419-878-8312
Practice Address - Fax:419-878-8844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3256111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU91632OtherUPIN
OH2356445Medicaid
OH7580510OtherAETNA
OH27882870801OtherMEDICAL MUTUAL OF OHIO
OH27882870800OtherWORKMAN'S COMPANSATION
OH=========OtherFRONTPATH
OH=========0A00OtherANTHEM BCBS
OH9327511Medicare PIN