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General NPI Number Information
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NPI Number | 1285814723
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Entity Type | Organization
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Legal Business Name | ANDERSON CHIROPRACTIC PC
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 12/19/2007
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Provider Practice Location Address
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Address Line | 3031 S RUSSELL ST STE 2
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City | MISSOULA
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State | MT
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Zip | 59801-8540
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Country | US
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Telephone | 406-721-9996
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Fax |
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Provider Business Mailing Address
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Address Line | 3031 S RUSSELL ST STE 2
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City | MISSOULA
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State | MT
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Zip | 59801-8540
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Country | US
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Telephone | 406-721-9996
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Fax |
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Authorized Official
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Title or Position | OWNER / PRESIDENT
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Name | DR. MICHAEL ALAN ANDERSON
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Credential | D.C.
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Telephone | 406-721-9996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 602
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License Number State | MT
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