MEDICARE: DR. CRAIG MARTIN 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	6610	MO

General Provider Information

NPI Number	:	1669443982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG MARTIN ANDERSON DC

Provider Business Mailing Address
First Line	:	19 MULLANPHY CT
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-3239
Country	:	US
Telephone Number	:	314-837-9911
Fax Number	:	314-699-9894

Provider Business Practice Location Address
First Line	:	315 LEMAY FERRY RD
Second Line	:	SUITE 132
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-1501
Country	:	US
Telephone Number	:	314-631-2255
Fax Number	:	314-638-7979

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

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	07/08/2007

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