MEDICARE: BRIAN JAY ANDERSON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4939	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8F5111	OTHER	TX	BLUE CROSS/BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023011988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN JAY ANDERSON D.C.

Provider Business Mailing Address
First Line	:	3950 SUNSET DR
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-5622
Country	:	US
Telephone Number	:	325-949-1600
Fax Number	:	325-944-3754

Provider Business Practice Location Address
First Line	:	3950 SUNSET DR
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-5622
Country	:	US
Telephone Number	:	325-949-1600
Fax Number	:	325-944-3754

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	10/04/2012

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