Michael Jay Anderson, DC
Individual provider Active NPI Chiropractor · Superior, WI
NPI 1104863257 · NPPES record last updated Jan 26, 2009
Key facts
- NPI
- 1104863257
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 2904 (WI)
- Practice address
- 2911 Tower Ave
Ste 4
Superior, WI 54880-5322 - Phone
- (715) 392-4883
- Fax
- (715) 392-4873
- NPI assigned
- May 31, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Northwestern College of Chiropractic, 1992
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
2911 Tower Ave
Suite 4
Superior, WI 54880-5394
Phone (715) 392-4883
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060714000067 | WI | Practitioner - Chiropractic | 0749293819 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Anderson Family Chiropractic SC | Chiropractor | Current |
Accepting new patients |
| Lake Superior Chiropractic Office, S.C. | Chiropractor | Past |
Accepting new patients |
| Omnia Wellness and Recovery | Past |
Accepting new patients |
Locations
1225 Tower Ave
Ste 102
Superior, WI 54880
Phone (715) 392-4883
2911 Tower Ave
Ste 4
Superior, WI 54880
Phone (715) 392-4883
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 2904 | WI | Yes |
Addresses
Primary practice location
2911 Tower Ave
Ste 4
Superior, WI 54880-5322
Mailing address
2911 Tower Ave
Ste 4
Superior, WI 54880-5322
Phone (715) 392-4883
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38872400 | Medicaid | WI |
Other providers in Superior, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 26, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.