Provider Demographics
NPI:1013071943
Name:ANDERSON, JAMES A (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
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 1:2903 E 42ND ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-3135
Mailing Address - Country:US
Mailing Address - Phone:612-722-2147
Mailing Address - Fax:
Practice Address - Street 1:2903 E 42ND ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-3135
Practice Address - Country:US
Practice Address - Phone:612-722-2147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3363111N00000X
MN508111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5374227-00Medicaid
MN43F05ANOtherBLUE CROSS BLUE SHIELD
MN350003039Medicare ID - Type Unspecified
MN5374227-00Medicaid