Healthcare Provider Details

I. General information

NPI: 1639192610
Provider Name (Legal Business Name): MICHAEL PATRICK ANDERSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3441 LAWRENCEVILLE SUWANEE RD. SUITE C
SUWANEE GA
30024
US

IV. Provider business mailing address

2133 HWY 317 SUITE 12-318
SUWANEE GA
30024-2649
US

V. Phone/Fax

Practice location:
  • Phone: 877-704-1761
  • Fax: 678-730-0280
Mailing address:
  • Phone: 877-704-1761
  • Fax: 678-730-0280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR007341
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: