Provider Demographics
NPI:1427235746
Name:ANDERSON CHIROPRACTIC CARE, P.A.
Entity type:Organization
Organization Name:ANDERSON CHIROPRACTIC CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEFF
Authorized Official - Middle Name:D
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-377-0551
Mailing Address - Street 1:9632 W EMERALD ST
Mailing Address - Street 2:SUITE 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 ST
Practice Address - Street 2:SUITE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDC529111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010007900OtherREGENCE BLUE SHIELD
IDC53295OtherBLUE CROSS OF IDAHO
IDC53295OtherBLUE CROSS OF IDAHO
ID1672054Medicare Oscar/Certification