Individual
DR. JIMMY G ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
3394 LAKE ELMO AVENUE NORTH, BOX 831, LAKE ELMO, MN 55042-0831
(651) 777-9757
(651) 777-9757
Mailing address
3394 LAKE ELMO AVENUE NORTH, BOX 831, LAKE ELMO, MN 55042-0831
(651) 777-9757
(651) 777-9757
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1217
MN
111N00000X
Chiropractor
3048
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0N362AN
BLUE CROSS BLUE SHIELD
MN
Enumeration date
12/06/2006
Last updated
07/08/2007
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