Scott Ravn Andersen, DC
Individual provider Active NPI Chiropractor · Ankeny, IA
NPI 1013095348 · NPPES record last updated May 3, 2021
Key facts
- NPI
- 1013095348
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- A05758 (IA)
- Practice address
- 7302 NW 19TH St
Ankeny, IA 50023-9374 - Phone
- (641) 780-9634
- NPI assigned
- Nov 2, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A05758 | IA | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | A05758 | IA | Yes |
Addresses
Primary practice location
7302 NW 19TH St
Ankeny, IA 50023-9374
Mailing address
7302 NW 19TH St
Ankeny, IA 50023-9374
Phone (641) 780-9634
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0109132 | Medicaid | IA | |
| 15746 | Other | IA | WELLMARK BCBS |
Other providers in Ankeny, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 3, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.