Healthcare Provider Details

I. General information

NPI: 1619960853
Provider Name (Legal Business Name): ANDERSON LIFE CHIROPRACTIC P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 E PRENTICE AVE SUITE 700
GREENWOOD VILLAGE CO
80111-2912
US

IV. Provider business mailing address

8400 E PRENTICE AVE SUITE 700
GREENWOOD VILLAGE CO
80111-2912
US

V. Phone/Fax

Practice location:
  • Phone: 720-316-2202
  • Fax: 303-840-7073
Mailing address:
  • Phone: 720-316-2202
  • Fax: 303-840-7073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5387
License Number StateCO

VIII. Authorized Official

Name: MR. THOMAS DEAN ANDERSON
Title or Position: CHIROPRACTOR/OWNER
Credential: D.C.
Phone: 720-316-2202