Individual
DR. GREGORY D ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
120 E OAK ST, LAKE MILLS, WI 53551-1243
(920) 648-2711
Mailing address
120 E OAK ST, LAKE MILLS, WI 53551-1243
(920) 648-2711
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1410
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38752200
—
WI
Enumeration date
08/10/2005
Last updated
07/08/2007
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