Healthcare Provider Details

I. General information

NPI: 1134662133
Provider Name (Legal Business Name): TODD ANDERSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2016
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 MAIN ST NW STE 2
ELK RIVER MN
55330-4521
US

IV. Provider business mailing address

231 MAIN ST NW STE 2
ELK RIVER MN
55330-4521
US

V. Phone/Fax

Practice location:
  • Phone: 636-735-3534
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberA53680489349
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2017007832
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1023
License Number StateWV
# 4
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number6888
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: