Healthcare Provider Details

I. General information

NPI: 1649506528
Provider Name (Legal Business Name): ERIN MARIE ANDERSON D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1342 VIRIDIAN PARK LN
ARLINGTON TX
76005-1186
US

IV. Provider business mailing address

1342 VIRIDIAN PARK LN
ARLINGTON TX
76005-1186
US

V. Phone/Fax

Practice location:
  • Phone: 612-280-6596
  • Fax:
Mailing address:
  • Phone: 612-280-6596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number14802
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number4902
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: