Provider Demographics
NPI:1487758728
Name:ANDERSON, RACHEL ANNE (DC, CMT)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:ANNE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DC, CMT
Other - Prefix:DR
Other - First Name:RACHEL
Other - Middle Name:ANNE
Other - Last Name:STADICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC, CMT
Mailing Address - Street 1:2480 YOUNGFIELD ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215
Mailing Address - Country:US
Mailing Address - Phone:303-237-7900
Mailing Address - Fax:303-237-7638
Practice Address - Street 1:28300 FRANKLIN RD STE A
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1657
Practice Address - Country:US
Practice Address - Phone:303-332-3366
Practice Address - Fax:303-237-7638
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5309111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
504438Medicare ID - Type Unspecified