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NPI Code Detail

MEDICARE: DR. KENDALL ANDERSON, P.C.

MEDICARE: DR. KENDALL ANDERSON, P.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
1261Q00000XClinic/Center695SD

General Provider Information

NPI Number : 1497920193
Entity Type Code : Organization
Provider Name (Legal Business Name) : DR. KENDALL ANDERSON, P.C.
Provider Business Mailing Address
First Line : 3618 CANYON LAKE DRIVE
Second Line : SUITE 114
City : RAPID CITY
State : SD
Zip : 57702-3129
Country : US
Telephone Number : 605-342-7110
Fax Number :
Provider Business Practice Location Address
First Line : 3618 CANYON LAKE DRIVE
Second Line : SUITE 114
City : RAPID CITY
State : SD
Zip : 57702-3129
Country : US
Telephone Number : 605-342-7110
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. KENDALL DUANE ANDERSON
Credential : D.C.
Telephone Number : 605-342-7110
Provider Enumeration Date : 04/24/2008
Last Update Date : 04/24/2008

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