Provider Demographics
NPI:1528304516
Name:ANDERSON FAMILY CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:ANDERSON FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-962-2244
Mailing Address - Street 1:12510 W 62ND TER
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-1802
Mailing Address - Country:US
Mailing Address - Phone:913-962-2244
Mailing Address - Fax:
Practice Address - Street 1:12510 W 62ND TER
Practice Address - Street 2:SUITE 101
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66216-1802
Practice Address - Country:US
Practice Address - Phone:913-962-2244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104194111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0006330Medicare PIN