Provider Demographics
NPI:1295935401
Name:ANDERSON CHIROPRACTIC INC
Entity type:Organization
Organization Name:ANDERSON CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-625-2225
Mailing Address - Street 1:1395 JORDAN ST STE D
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-4759
Mailing Address - Country:US
Mailing Address - Phone:319-625-2225
Mailing Address - Fax:319-625-2227
Practice Address - Street 1:1395 JORDAN ST STE D
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-4759
Practice Address - Country:US
Practice Address - Phone:319-625-2225
Practice Address - Fax:319-625-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05981111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0151472Medicaid
IA58531OtherBC/BS
IAI9819Medicare PIN