Provider Demographics
NPI:1649271644
Name:ANDERSON, VERNON J (DC)
Entity type:Individual
Prefix:DR
First Name:VERNON
Middle Name:J
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 1:653 CHESTNUT ST
Mailing Address - Street 2:PO BOX 272
Mailing Address - City:DAWSON
Mailing Address - State:MN
Mailing Address - Zip Code:56232-0272
Mailing Address - Country:US
Mailing Address - Phone:320-769-4747
Mailing Address - Fax:
Practice Address - Street 1:653 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:DAWSON
Practice Address - State:MN
Practice Address - Zip Code:56232-0272
Practice Address - Country:US
Practice Address - Phone:320-769-4747
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1801111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN44012ANOtherBLUECROSS BLUESHIELD
MN603594OtherCHIRO. CARE OF MN CCMI
MN0555OtherHEALTH SERVICES MANAGEMEN
MN0555OtherHEALTH SERVICES MANAGEMEN