MEDICARE: DR. JORDAN MASSEY ANDERSON 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	B01509	NV

General Provider Information

NPI Number	:	1073955753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORDAN MASSEY ANDERSON DC

Provider Business Mailing Address
First Line	:	PO BOX 36853
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-6853
Country	:	US
Telephone Number	:	702-644-3333
Fax Number	:	702-644-3336

Provider Business Practice Location Address
First Line	:	2425 N LAMB BLVD
Second Line	:	STE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-5420
Country	:	US
Telephone Number	:	702-644-9155
Fax Number	:

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

Provider Enumeration Date	:	07/23/2013
Last Update Date	:	01/31/2014

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Directions to “ DR. JORDAN MASSEY ANDERSON DC” Practice Location

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