Doctor Name: | JUSTIN MICHAEL ANDERSON |
NPI Number: | 1245694041 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DC |
License Number: | CHIA-1675 |
Business Practice Address: | 950 E Riverside Dr Eagle, ID - 836166020 |
Business Phone Number: | 2089392502 |
Business Fax Number: | |
Mailing Address: | 2521 N Cisco Ln, BOISE |
State: | ID |
Postal Code: | 837025502 |
Phone Number: | 7128998984 |
Fax Number: | |
NPI Enumeration Date: | 04/07/2016 |
NPI Last Update Date: | 04/07/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | CHIA-1675 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |