Provider Demographics
NPI:1154553394
Name:MADHERE, ANDREA SAMANTHA (DC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:SAMANTHA
Last Name:MADHERE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24100 DRAKE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-3155
Mailing Address - Country:US
Mailing Address - Phone:248-471-5554
Mailing Address - Fax:
Practice Address - Street 1:24100 DRAKE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-3155
Practice Address - Country:US
Practice Address - Phone:248-471-5554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009591111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor