Provider Demographics
NPI:1669538708
Name:ANDERSON, MICHAEL FRANCIS (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FRANCIS
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 1:1099 MERCHANTS DR STE B
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-3005
Mailing Address - Country:US
Mailing Address - Phone:770-443-4225
Mailing Address - Fax:770-443-3890
Practice Address - Street 1:1099 MERCHANTS DR STE B
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-3005
Practice Address - Country:US
Practice Address - Phone:770-443-4225
Practice Address - Fax:770-443-3890
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005499111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA143966Medicare UPIN
GA35ZCDQQMedicare ID - Type Unspecified