Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath |
NPI | 1073974002 |
---|---|
Provider Name | Dr. Kenton Anderson |
First Address | Evanston, IL 60202-1003 |
Second Address | Evanston, IL 60202-1003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2016 |
Last Update Date | 18/03/2016 |