Jerry S Anderson, DC
Individual provider Active NPI Chiropractor · Winchester, TN
NPI 1942299573 · NPPES record last updated Aug 29, 2011
Key facts
- NPI
- 1942299573
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 491 (TN)
- Practice address
- 1431 S College St
Winchester, TN 37398-2414 - Phone
- (931) 967-6308
- Fax
- (931) 968-9221
- NPI assigned
- Oct 17, 2005
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|
| 491 | TN | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 491 | TN | Yes |
Addresses
Primary practice location
1431 S College St
Winchester, TN 37398-2414
Mailing address
1431 S College St
Winchester, TN 37398-2414
Phone (931) 967-6308
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3673947 | Medicaid | TN | |
| 0066336 | Other | BLUE CROSS |
Other providers in Winchester, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 29, 2011. 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.