Healthcare Provider Details

I. General information

NPI: 1477787174
Provider Name (Legal Business Name): GRANT MICHAEL ANDERSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2009
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 MAIN AVE S
BROOKINGS SD
57006-3839
US

IV. Provider business mailing address

1204 MAIN AVE S
BROOKINGS SD
57006-3839
US

V. Phone/Fax

Practice location:
  • Phone: 605-692-4325
  • Fax: 605-301-4141
Mailing address:
  • Phone: 605-692-4325
  • Fax: 605-301-4141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1145
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: