Healthcare Provider Details

I. General information

NPI: 1255614301
Provider Name (Legal Business Name): ANDERSON CHIROPRACTIC OFFICE,S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E STATE ST
MAUSTON WI
53948-1344
US

IV. Provider business mailing address

115 E STATE ST
MAUSTON WI
53948-1344
US

V. Phone/Fax

Practice location:
  • Phone: 608-524-2616
  • Fax:
Mailing address:
  • Phone: 608-524-2616
  • Fax: 608-524-3697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1736
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: TRACY BENESH
Title or Position: CLINIC DIRECTOR
Credential:
Phone: 608-524-2616