Provider Demographics
NPI:1265551576
Name:ANDERSON, THOMAS DEAN (DC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:DEAN
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 1:8400 E PRENTICE AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2912
Mailing Address - Country:US
Mailing Address - Phone:720-316-2202
Mailing Address - Fax:303-840-7073
Practice Address - Street 1:8400 E PRENTICE AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2912
Practice Address - Country:US
Practice Address - Phone:720-316-2202
Practice Address - Fax:303-840-7073
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5387111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO486958Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
COU94040Medicare UPIN