MEDICARE: ANDERSON SPECIFIC CHIROPRACTIC

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	005499	GA

General Provider Information

NPI Number	:	1699972703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDERSON SPECIFIC CHIROPRACTIC

Provider Business Mailing Address
First Line	:	1099 MERCHANTS DR
Second Line	:	STE B
City	:	DALLAS
State	:	GA
Zip	:	30132-3004
Country	:	US
Telephone Number	:	770-443-4225
Fax Number	:	770-443-3890

Provider Business Practice Location Address
First Line	:	1099 MERCHANTS DR
Second Line	:	STE B
City	:	DALLAS
State	:	GA
Zip	:	30132-3004
Country	:	US
Telephone Number	:	770-443-4225
Fax Number	:	770-443-3890

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL FRANCIS ANDERSON
Credential	:	D.C.
Telephone Number	:	770-443-4225

Provider Enumeration Date	:	07/02/2007
Last Update Date	:	08/22/2020

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