Provider Demographics
NPI:1487952933
Name:ANDERSON, KEVIN D (DC)
Entity type:Individual
Prefix:
First Name:KEVIN
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 1:1549 FORT HARRISON RD
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-1332
Mailing Address - Country:US
Mailing Address - Phone:812-460-4700
Mailing Address - Fax:812-460-4701
Practice Address - Street 1:1549 FORT HARRISON RD
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-1332
Practice Address - Country:US
Practice Address - Phone:812-460-4700
Practice Address - Fax:812-460-4701
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002805A111N00000X
KY5281111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor