Provider Demographics
NPI:1063546851
Name:ANDREW I SOLOMON DC SC
Entity type:Organization
Organization Name:ANDREW I SOLOMON DC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:IRA
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-552-7999
Mailing Address - Street 1:4401 TAYLOR AVENUE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-4679
Mailing Address - Country:US
Mailing Address - Phone:262-552-7999
Mailing Address - Fax:262-552-7998
Practice Address - Street 1:4401 TAYLOR AVENUE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-4679
Practice Address - Country:US
Practice Address - Phone:262-552-7999
Practice Address - Fax:262-552-7998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1406012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI088387499002OtherBLUE CROSS
WI38752300Medicaid
WI38752300Medicaid