Provider Demographics
NPI:1356372742
Name:ANDERSON, MITCHELL A (DC)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:A
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1605 LOSEY BLVD S
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-6151
Mailing Address - Country:US
Mailing Address - Phone:608-788-7880
Mailing Address - Fax:608-788-2920
Practice Address - Street 1:1605 LOSEY BLVD S
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-6151
Practice Address - Country:US
Practice Address - Phone:608-788-7880
Practice Address - Fax:608-788-2920
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2009-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1080111N00000X
IA007056111N00000X
WI4497-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor