Provider Demographics
NPI:1528166402
Name:ANDERSON, GUNNAR J (DC)
Entity type:Individual
Prefix:DR
First Name:GUNNAR
Middle Name:J
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 1:3926 SANDALWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-2586
Mailing Address - Country:US
Mailing Address - Phone:719-566-1550
Mailing Address - Fax:719-565-2661
Practice Address - Street 1:3926 SANDALWOOD LN
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-2586
Practice Address - Country:US
Practice Address - Phone:719-566-1550
Practice Address - Fax:719-565-2661
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5047111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP01008555OtherRAILROAD MEDICARE
U84247Medicare UPIN
COCOA106369Medicare PIN