1972694313 NPI number — DONALD J ANDERSON D.C.

Table of content: DONALD J ANDERSON D.C. (NPI 1972694313)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972694313 NPI number — DONALD J ANDERSON D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
DONALD
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1972694313
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 HOLIDAY DR
Provider Second Line Business Mailing Address:
SUITE 22
Provider Business Mailing Address City Name:
WHITE RIVER JUNCTION
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05001-2043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-295-9360
Provider Business Mailing Address Fax Number:
802-295-9360

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 HOLIDAY DR
Provider Second Line Business Practice Location Address:
SUITE 22
Provider Business Practice Location Address City Name:
WHITE RIVER JUNCTION
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05001-2043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-295-9360
Provider Business Practice Location Address Fax Number:
802-295-9360
Provider Enumeration Date:
09/28/2006

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:  006 0000889 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: HARVARD PILGRIM . This is a "U21928" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 03036 . This is a "CBA" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 0506153Y0VT01 . This is a "ANTHEM BC/BC" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: ANDE00018294 . This is a "BC/BS VERMONT" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: VT0889B . This is a "LANDMARK" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 030331022 . This is a "CHAMPUS TRICARE NORTH" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 0VN0183 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 030331022 0004 . This is a "CIGNA 2 OF 2" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 9962540 . This is a "CIGNA 1 OF 2" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 0004461724 . This is a "AETNA" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 98L1002 . This is a "MVP" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: P00213645 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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