Provider Demographics
NPI:1699801662
Name:ANDERSON, JEFFREY M (D C)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 S WADSWORTH BLVD
Mailing Address - Street 2:BUILDING D SUITE 205
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-5122
Mailing Address - Country:US
Mailing Address - Phone:303-986-5400
Mailing Address - Fax:303-986-5401
Practice Address - Street 1:3333 S WADSWORTH BLVD
Practice Address - Street 2:BUILDING D SUITE 205
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-5122
Practice Address - Country:US
Practice Address - Phone:303-986-5400
Practice Address - Fax:303-986-5401
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO841560976111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO350053223OtherRAIL ROAD MEDICARE ID
CO841560976OtherEIN
COC46983Medicare PIN