Provider Demographics
NPI:1427249101
Name:JADEAN ANDERSON P.C.
Entity type:Organization
Organization Name:JADEAN ANDERSON P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JADEAN
Authorized Official - Middle Name:JAKE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-241-7737
Mailing Address - Street 1:4132 30TH AVE S
Mailing Address - Street 2:SUITE #102
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8407
Mailing Address - Country:US
Mailing Address - Phone:701-241-7737
Mailing Address - Fax:701-241-7738
Practice Address - Street 1:4132 30TH AVE S
Practice Address - Street 2:SUITE #102
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8407
Practice Address - Country:US
Practice Address - Phone:701-241-7737
Practice Address - Fax:701-241-7738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDAND28655OtherBLUE CROSS BLUE SHIELD ND
NDN712754Medicare PIN
NDAND28655OtherBLUE CROSS BLUE SHIELD ND