Provider Demographics
NPI:1013095348
Name:ANDERSEN, SCOTT RAVN (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:RAVN
Last Name:ANDERSEN
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 1:7302 NW 19TH ST
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-9374
Mailing Address - Country:US
Mailing Address - Phone:641-780-9634
Mailing Address - Fax:
Practice Address - Street 1:7302 NW 19TH ST
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-9374
Practice Address - Country:US
Practice Address - Phone:641-780-9634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05758111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0109132Medicaid
IA15746OtherWELLMARK BCBS
IA157461Medicare PIN