Provider Demographics
NPI:1063590206
Name:ANDERSON, GEFF D (DC)
Entity type:Individual
Prefix:DR
First Name:GEFF
Middle Name:D
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 1:9632 W EMERALD
Mailing Address - Street 2:STE A
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9762
Mailing Address - Country:US
Mailing Address - Phone:208-377-0551
Mailing Address - Fax:208-377-0557
Practice Address - Street 1:9632 W EMERALD
Practice Address - Street 2:STE A
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9762
Practice Address - Country:US
Practice Address - Phone:208-377-0551
Practice Address - Fax:208-377-0557
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDC529111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
000010007900OtherBS
C5295OtherBC
000010007900OtherBS
T44510Medicare UPIN