Provider Demographics
NPI:1982618187
Name:ANDERSON, JAMES MITCHELL (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MITCHELL
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 1:3939 W 69TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2001
Mailing Address - Country:US
Mailing Address - Phone:952-562-2420
Mailing Address - Fax:952-562-2421
Practice Address - Street 1:3939 W 69TH ST STE B
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2001
Practice Address - Country:US
Practice Address - Phone:952-562-2420
Practice Address - Fax:952-562-2421
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4282111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN582425700Medicaid
MN606K9CAOtherBLUE CROSS BLUE SHIELD