Healthcare Provider Details

I. General information

NPI: 1134334766
Provider Name (Legal Business Name): DREW TYLER ANDERSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 1ST ST SW
WAGNER SD
57380
US

IV. Provider business mailing address

8525 CARDIFF LN
EDEN PRAIRIE MN
55344-7673
US

V. Phone/Fax

Practice location:
  • Phone: 605-384-5419
  • Fax: 605-384-5410
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1112
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: