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General NPI Number Information
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NPI Number | 1417226044
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Entity Type | Organization
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Legal Business Name | ANDERSON CHIROPRACTIC LLC
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Dates
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Enumeration Date | 12/28/2011
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Last Update Date | 05/09/2012
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Provider Practice Location Address
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Address Line | 3926 SANDALWOOD LN
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City | PUEBLO
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State | CO
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Zip | 81005-2586
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Country | US
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Telephone | 719-566-1550
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Fax | 719-565-2661
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Provider Business Mailing Address
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Address Line | 3926 SANDALWOOD LN
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City | PUEBLO
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State | CO
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Zip | 81005-2586
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Country | US
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Telephone | 719-566-1550
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Fax | 719-565-2661
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Authorized Official
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Title or Position | OWNER
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Name | DR. GUNNAR ANDERSON
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Credential |
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Telephone | 719-566-1550
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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 | 5047
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License Number State | CO
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