Provider Demographics
NPI:1699070755
Name:ANDERSON CHIROPRACTIC LLC
Entity type:Organization
Organization Name:ANDERSON CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:802-295-9360
Mailing Address - Street 1:PO BOX 181
Mailing Address - Street 2:
Mailing Address - City:WILDER
Mailing Address - State:VT
Mailing Address - Zip Code:05088-0181
Mailing Address - Country:US
Mailing Address - Phone:802-295-9360
Mailing Address - Fax:802-295-9360
Practice Address - Street 1:2577 HARTFORD AVE
Practice Address - Street 2:
Practice Address - City:WILDER
Practice Address - State:VT
Practice Address - Zip Code:05088
Practice Address - Country:US
Practice Address - Phone:802-295-9360
Practice Address - Fax:802-295-9360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT889111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTU2198Medicare UPIN