Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 602 | MT |
N | 111NS0005X | Chiropractic Sports Physician | 602 | MT |
NPI | 1134278682 |
---|---|
Provider Name | Dr. Michael Alan Anderson |
First Address | Missoula, MT 59801-8540 |
Second Address | Missoula, MT 59801-8540 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 18/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
40150 | BLUE CROSS BLUE SHIELD MT (01) | MT |