MEDICARE: ETHAN LEE ANDERSEN DC

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	CH61613395	WA

General Provider Information

NPI Number	:	1063232031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ETHAN LEE ANDERSEN DC

Provider Business Mailing Address
First Line	:	9720 N NEVADA ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99218-3412
Country	:	US
Telephone Number	:	509-464-2273
Fax Number	:	509-242-1854

Provider Business Practice Location Address
First Line	:	9720 N NEVADA ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99218-3412
Country	:	US
Telephone Number	:	509-464-2273
Fax Number	:	509-242-1854

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

Provider Enumeration Date	:	10/15/2024
Last Update Date	:	01/08/2026

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Directions to “ ETHAN LEE ANDERSEN DC” Practice Location

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