MEDICARE: CURTIS A. ANDERSON, PA

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	CH5554	FL

General Provider Information

NPI Number	:	1558630939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CURTIS A. ANDERSON, PA

Provider Business Mailing Address
First Line	:	2574 US HIGHWAY 90 W
Second Line	:
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32433-6733
Country	:	US
Telephone Number	:	850-892-7432
Fax Number	:

Provider Business Practice Location Address
First Line	:	2574 US HIGHWAY 90 W
Second Line	:
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32433-6733
Country	:	US
Telephone Number	:	850-892-7432
Fax Number	:

Authorized Official
Title or Position	:	PRES
Name	:	CURTIS AUBREY ANDERSON
Credential	:	D.C.
Telephone Number	:	850-892-7432

Provider Enumeration Date	:	12/14/2011
Last Update Date	:	12/14/2011

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