MEDICARE: DR. JEFFREY M 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	841560976	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	350053223	OTHER	CO	RAIL ROAD MEDICARE ID

General Provider Information

NPI Number	:	1699801662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY M ANDERSON D C

Provider Business Mailing Address
First Line	:	3333 S WADSWORTH BLVD
Second Line	:	BUILDING D SUITE 205
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-5122
Country	:	US
Telephone Number	:	303-986-5400
Fax Number	:	303-986-5401

Provider Business Practice Location Address
First Line	:	3333 S WADSWORTH BLVD
Second Line	:	BUILDING D SUITE 205
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-5122
Country	:	US
Telephone Number	:	303-986-5400
Fax Number	:	303-986-5401

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	01/17/2014

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