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General NPI Number Information
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NPI Number | 1093961401
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Entity Type | Organization
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Legal Business Name | ANDERSON FAMILY CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 08/18/2008
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Provider Practice Location Address
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Address Line | 121 E MAIN ST SUITE 102
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City | MANKATO
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State | MN
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Zip | 56001-3579
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Country | US
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Telephone | 507-388-5315
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Fax | 507-388-2699
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Provider Business Mailing Address
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Address Line | 121 E MAIN ST SUITE 102
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City | MANKATO
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State | MN
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Zip | 56001-3579
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Country | US
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Telephone | 507-388-5315
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Fax | 507-388-2699
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRYCE DOUGLAS ANDERSON
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Credential | D.C.
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Telephone | 507-388-5315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4350
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License Number State | MN
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