MEDICARE: ERIN MARIE ANDERSON D.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
1	111NP0017X	Pediatric Chiropractor	14802	TX
2	111NP0017X	Pediatric Chiropractor	4902	MN

General Provider Information

NPI Number	:	1649506528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN MARIE ANDERSON D.C.

Provider Business Mailing Address
First Line	:	1342 VIRIDIAN PARK LN
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76005-1186
Country	:	US
Telephone Number	:	612-280-6596
Fax Number	:

Provider Business Practice Location Address
First Line	:	1342 VIRIDIAN PARK LN
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76005-1186
Country	:	US
Telephone Number	:	612-280-6596
Fax Number	:

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

Provider Enumeration Date	:	10/27/2009
Last Update Date	:	09/20/2021

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