Provider Demographics
NPI:1770884546
Name:ANDERSON, DEREK STEVEN (DC)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:STEVEN
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 1:14413 EXCELSIOR BLVD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-5821
Mailing Address - Country:US
Mailing Address - Phone:952-746-1506
Mailing Address - Fax:952-746-1508
Practice Address - Street 1:14413 EXCELSIOR BLVD
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-5821
Practice Address - Country:US
Practice Address - Phone:952-746-1506
Practice Address - Fax:952-746-1508
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31664111N00000X
MN5624111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor