MEDICARE: DR. JEFFERY A. ANDERSON DC

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	A5539	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	04999	OTHER	BLUE CROSS BLUE SHIELD
3	21297	OTHER	MIDLAND CHOICE

General Provider Information

NPI Number	:	1710958707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFERY A. ANDERSON DC

Provider Business Mailing Address
First Line	:	614 BUDDY HOLLY PLACE
Second Line	:
City	:	CLEAR LAKE
State	:	IA
Zip	:	50428-1364
Country	:	US
Telephone Number	:	641-357-8659
Fax Number	:	641-357-0799

Provider Business Practice Location Address
First Line	:	614 BUDDY HOLLY PLACE
Second Line	:
City	:	CLEAR LAKE
State	:	IA
Zip	:	50428-1364
Country	:	US
Telephone Number	:	641-357-8659
Fax Number	:	641-357-0799

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	10/16/2007

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