MEDICARE: KENNETH RAYMOND ANDERSEN 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	111N00000X	Chiropractor	49216121202	UT

General Provider Information

NPI Number	:	1760483986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH RAYMOND ANDERSEN D.C.

Provider Business Mailing Address
First Line	:	9035 S 1300 E
Second Line	:	SUITE 2B
City	:	SANDY
State	:	UT
Zip	:	84094-3131
Country	:	US
Telephone Number	:	801-572-5696
Fax Number	:	801-572-5753

Provider Business Practice Location Address
First Line	:	9035 S 1300 E
Second Line	:	SUITE 2B
City	:	SANDY
State	:	UT
Zip	:	84094-3132
Country	:	US
Telephone Number	:	801-572-5696
Fax Number	:	801-572-5753

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	05/28/2010

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