1669443982 NPI number — DR. CRAIG MARTIN ANDERSON DC

Table of content: DR. CRAIG MARTIN ANDERSON DC (NPI 1669443982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669443982 NPI number — DR. CRAIG MARTIN ANDERSON DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
CRAIG
Provider Middle Name:
MARTIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669443982
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19 MULLANPHY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORISSANT
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63031-3239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-837-9911
Provider Business Mailing Address Fax Number:
314-699-9894

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 LEMAY FERRY RD
Provider Second Line Business Practice Location Address:
SUITE 132
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63125-1501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-631-2255
Provider Business Practice Location Address Fax Number:
314-638-7979
Provider Enumeration Date:
01/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  6610 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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