Provider Demographics
NPI:1831233394
Name:ANDERSON, JEFFREY P (DC, DABCI)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:P
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DC, DABCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 CAHILL RD
Mailing Address - Street 2:SUITE 23
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2018
Mailing Address - Country:US
Mailing Address - Phone:952-943-1170
Mailing Address - Fax:
Practice Address - Street 1:7001 CAHILL RD
Practice Address - Street 2:SUITE 23
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2018
Practice Address - Country:US
Practice Address - Phone:952-943-1170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2468111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN98672ANMedicare UPIN