Provider Demographics
NPI:1942299573
Name:ANDERSON, JERRY S (DC)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:S
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 1:1431 S COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-2414
Mailing Address - Country:US
Mailing Address - Phone:931-967-6308
Mailing Address - Fax:931-968-9221
Practice Address - Street 1:1431 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2414
Practice Address - Country:US
Practice Address - Phone:931-967-6308
Practice Address - Fax:931-968-9221
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN491111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3673947Medicaid
0066336OtherBLUE CROSS
3673947Medicare ID - Type Unspecified
T74636Medicare UPIN