MEDICARE: MARK ANDERSON FAMILY CHIROPRACTIC INC

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	06872	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184758625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK ANDERSON FAMILY CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	5161 MAPLE DR
Second Line	:	SUITE D
City	:	PLEASANT HILL
State	:	IA
Zip	:	50327-8454
Country	:	US
Telephone Number	:	515-266-6090
Fax Number	:	515-266-6150

Provider Business Practice Location Address
First Line	:	5161 MAPLE DR
Second Line	:	SUITE D
City	:	PLEASANT HILL
State	:	IA
Zip	:	50327-8454
Country	:	US
Telephone Number	:	515-266-6090
Fax Number	:	515-266-6150

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK ANDERSON
Credential	:	D.C.
Telephone Number	:	515-266-6090

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	01/14/2015

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