Individual
JADEAN JAKE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
4132 30TH AVE SOUTH, SUITE #102, FARGO, ND 58104-8407
(701) 241-7737
(701) 241-7738
Mailing address
4132 30TH AVE SOUTH, SUITE #102, FARGO, ND 58104-8407
(701) 371-2298
(701) 241-7738
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
390200000X
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AND28655
BLUE CROSS BLUE SHIELD ND
ND
Enumeration date
07/02/2007
Last updated
10/03/2007
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