Andersen Chiropractic, LLC – Chiropractor

Key facts

NPI: 1376737247
Entity type: Organization (NPI type 2)
Primary specialty: Chiropractor 111N00000X
License: 49216121202 (UT)
Legal business name: ANDERSEN CHIROPRACTIC, LLC
Practice address: 1025 E 11400 S Ste 102
Sandy, UT 84094-6947
Phone: (801) 572-5696
Fax: (801) 938-9574
NPI assigned: Sep 4, 2007
Organization subpart: No

Authorized official

Name: Ken Andersen, D.C.
Title: Chiropractor
Phone: (801) 569-8787

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Kenneth Raymond Andersen, D.C. Chiropractor · Sandy, UT · NPI 1760483986

Medicare reassignment NPD CHIROPRACTOR · UT

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
46D2093689	Andersen Chiropractic, LLC 1025 East 11400 South, Suite 102, Sandy, UT 84094	Certificate of waiver	Apr 1, 2027

Medicare participation

Medicare fee-for-service enrollment: Enrolled in UT

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20040427001386	UT	Part B Supplier - Clinic/Group Practice	7416944921	Receives reassigned benefits from 1 practitioner Practice locations: Sandy, UT

National Provider Directory

Locations

1025 E 11400 S
Ste 102
Sandy, UT 84094
Phone (801) 572-5696

9035 S 1300 E
#110
Sandy, UT 84094
Phone (801) 572-5696

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Chiropractor Group: 193400000X SINGLE SPECIALTY GROUP	111N00000X	49216121202	UT	Yes

Addresses

Primary practice location

1025 E 11400 S Ste 102
Sandy, UT 84094-6947

Mailing address

1025 E 11400 S Ste 102
Sandy, UT 84094-6947
Phone (801) 572-5696

Other practice location 1

9035 S 1300 E Ste 2B
Sandy, UT 84094-3131
Phone (801) 572-5696

Other providers in Sandy, UT

Jessie Lee Ampuero
Abigail Anaya-Figueroa, BS IN PSYCHOLOGY
Matthew Ancel
Carolyn Anctil, MD
Peter Anders, CRNA
Allan L Andersen, MS
Kenneth Raymond Andersen, D.C.
Anderson Wellness Group LLC
Anderson Wellness Group LLC
Benjamin Luke Anderson, ACMHC

All providers in Sandy, UT · Chiropractor in Utah

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 9, 2018. 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.

Verify at the official NPI Registry.