MEDICARE: DR. STEPHANIE S ANDERSON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	08002806A	IN
2	111N00000X	Chiropractor	5282	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467750463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE S ANDERSON D.C.

Provider Business Mailing Address
First Line	:	1549 FORT HARRISON RD
Second Line	:
City	:	TERRE HAUTE
State	:	IN
Zip	:	47804-1332
Country	:	US
Telephone Number	:	812-460-4700
Fax Number	:	812-460-4701

Provider Business Practice Location Address
First Line	:	1549 FORT HARRISON RD
Second Line	:
City	:	TERRE HAUTE
State	:	IN
Zip	:	47804-1332
Country	:	US
Telephone Number	:	812-460-4700
Fax Number	:	812-460-4701

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2011
Last Update Date	:	12/10/2014

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