Provider Demographics
NPI:1972694313
Name:ANDERSON, DONALD J (DC)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 HOLIDAY DR
Mailing Address - Street 2:SUITE 22
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05001-2043
Mailing Address - Country:US
Mailing Address - Phone:802-295-9360
Mailing Address - Fax:802-295-9360
Practice Address - Street 1:222 HOLIDAY DR
Practice Address - Street 2:SUITE 22
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-2043
Practice Address - Country:US
Practice Address - Phone:802-295-9360
Practice Address - Fax:802-295-9360
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006 0000889111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTHARVARD PILGRIMOtherU21928
VT03036OtherCBA
VT0506153Y0VT01OtherANTHEM BC/BC
VTANDE00018294OtherBC/BS VERMONT
VTVT0889BOtherLANDMARK
VT030331022OtherCHAMPUS TRICARE NORTH
VT0VN0183Medicaid
VT030331022 0004OtherCIGNA 2 OF 2
VT9962540OtherCIGNA 1 OF 2
VT0004461724OtherAETNA
VT98L1002OtherMVP
VTP00213645OtherRAILROAD MEDICARE
VT030331022OtherCHAMPUS TRICARE NORTH
VTHARVARD PILGRIMOtherU21928