Individual
ROY ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
2939 NEW PINERY RD, PORTAGE, WI 53901-9226
(608) 742-8389
Mailing address
2939 NEW PINERY RD, PORTAGE, WI 53901-9226
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2830
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
400000157010
BLUE CROSS BLUE SHIELD
WI
Enumeration date
01/22/2007
Last updated
07/08/2007
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