Healthcare Provider Details

I. General information

NPI: 1699070755
Provider Name (Legal Business Name): ANDERSON CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2011
Last Update Date: 01/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2577 HARTFORD AVE
WILDER VT
05088
US

IV. Provider business mailing address

PO BOX 181
WILDER VT
05088-0181
US

V. Phone/Fax

Practice location:
  • Phone: 802-295-9360
  • Fax: 802-295-9360
Mailing address:
  • Phone: 802-295-9360
  • Fax: 802-295-9360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number889
License Number StateVT

VIII. Authorized Official

Name: DR. DONALD J ANDERSON
Title or Position: OWNER
Credential: D.C.
Phone: 802-295-9360