Healthcare Provider Details

I. General information

NPI: 1417768961
Provider Name (Legal Business Name): ANDERSON CHIROPRACTIC CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W MAIN ST
FREDERICKSBURG IA
50630-7705
US

IV. Provider business mailing address

PO BOX 207
FREDERICKSBURG IA
50630-0207
US

V. Phone/Fax

Practice location:
  • Phone: 563-237-6560
  • Fax: 563-237-6562
Mailing address:
  • Phone: 563-237-6560
  • Fax: 563-237-6562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: SAWYER A ANDERSON
Title or Position: OWNER/SOLE MEMBER
Credential: D.C.
Phone: 641-229-5018