Provider Demographics
NPI:1205987237
Name:ANDERSON FAMILY CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:ANDERSON FAMILY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ALDEN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-252-7070
Mailing Address - Street 1:8088 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-2450
Mailing Address - Country:US
Mailing Address - Phone:515-252-7070
Mailing Address - Fax:515-252-7670
Practice Address - Street 1:8088 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-2450
Practice Address - Country:US
Practice Address - Phone:515-252-7070
Practice Address - Fax:515-252-7670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0472860Medicaid
IA1144215518Medicare UPIN
IAI16375Medicare ID - Type UnspecifiedGROUP MEDICARE #
IAI16374Medicare ID - Type UnspecifiedT. ANDERSON INDIV PROV #