Provider Demographics
NPI:1366938946
Name:ANDERSON, COLTON JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:COLTON
Middle Name:JAMES
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3381 W MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-1008
Mailing Address - Country:US
Mailing Address - Phone:630-377-7788
Mailing Address - Fax:630-377-7802
Practice Address - Street 1:40W201 WASCO RD STE AB
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-8509
Practice Address - Country:US
Practice Address - Phone:630-377-7788
Practice Address - Fax:630-377-7802
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013240111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor