MEDICARE: DR. TRENT 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	111N00000X	Chiropractor	6051	MN

General Provider Information

NPI Number	:	1821481201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRENT ANDERSON D.C.

Provider Business Mailing Address
First Line	:	13635 NORTHDALE BLVD
Second Line	:
City	:	ROGERS
State	:	MN
Zip	:	55374-2142
Country	:	US
Telephone Number	:	763-276-6246
Fax Number	:

Provider Business Practice Location Address
First Line	:	2012 LOUISIANA AVE S
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55426-2721
Country	:	US
Telephone Number	:	520-977-7834
Fax Number	:

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

Provider Enumeration Date	:	03/10/2015
Last Update Date	:	09/21/2015

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