MEDICARE: DR. MARISA D 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	5120	WI
2	111N00000X	Chiropractor	6085	MN

General Provider Information

NPI Number	:	1699140756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARISA D ANDERSON DC

Provider Business Mailing Address
First Line	:	1380 N ACRES RD
Second Line	:	SUITE A
City	:	PRESCOTT
State	:	WI
Zip	:	54021-7061
Country	:	US
Telephone Number	:	715-262-8555
Fax Number	:	715-262-8744

Provider Business Practice Location Address
First Line	:	1380 N ACRES RD
Second Line	:	SUITE A
City	:	PRESCOTT
State	:	WI
Zip	:	54021-7061
Country	:	US
Telephone Number	:	715-262-8555
Fax Number	:	715-262-8744

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

Provider Enumeration Date	:	12/01/2015
Last Update Date	:	12/01/2015

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Directions to “ DR. MARISA D ANDERSON DC” Practice Location

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