Provider Demographics
NPI:1699587006
Name:ANDERSON WELLNESS GROUP LLC
Entity type:Organization
Organization Name:ANDERSON WELLNESS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-330-0011
Mailing Address - Street 1:45 W SEGO LILY DR STE 307
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-3660
Mailing Address - Country:US
Mailing Address - Phone:801-676-9452
Mailing Address - Fax:801-206-9734
Practice Address - Street 1:45 W SEGO LILY DR STE 307
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-3660
Practice Address - Country:US
Practice Address - Phone:801-676-9452
Practice Address - Fax:801-206-9734
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANDERSON WELLNESS GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty