Provider Demographics
NPI:1316278849
Name:ANONSON, CHAD (DC)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:
Last Name:ANONSON
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 1:1121 W PROSPECT RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-5623
Mailing Address - Country:US
Mailing Address - Phone:970-377-0918
Mailing Address - Fax:970-221-2437
Practice Address - Street 1:1121 W PROSPECT RD
Practice Address - Street 2:SUITE B
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-5623
Practice Address - Country:US
Practice Address - Phone:970-377-0918
Practice Address - Fax:970-221-2437
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6464111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA109098OtherMEDICARE PTAN
COCOA109097OtherMEDICARE PTAN