Provider Demographics
NPI:1932475498
Name:JEFFREY M ANDERSON DCPC
Entity Type:Organization
Organization Name:JEFFREY M ANDERSON DCPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-986-5400
Mailing Address - Street 1:3333 S WADSWORTH BLVD
Mailing Address - Street 2:BUILDING D SUITE 205
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-5122
Mailing Address - Country:US
Mailing Address - Phone:303-986-5400
Mailing Address - Fax:303-986-5401
Practice Address - Street 1:3333 S WADSWORTH BLVD
Practice Address - Street 2:BUILDING D SUITE 205
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-5122
Practice Address - Country:US
Practice Address - Phone:303-986-5400
Practice Address - Fax:303-986-5401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC46983Medicare PIN