Healthcare Provider Details

I. General information

NPI: 1619121662
Provider Name (Legal Business Name): KRISTIAN R ANDERSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 03/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 S WASHINGTON ST STE 100
GRAND FORKS ND
58201-7184
US

IV. Provider business mailing address

4350 S WASHINGTON ST STE 100
GRAND FORKS ND
58201-7184
US

V. Phone/Fax

Practice location:
  • Phone: 701-732-2888
  • Fax: 701-757-1213
Mailing address:
  • Phone: 701-732-2888
  • Fax: 701-757-1213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number906
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: