Provider Demographics
NPI:1336684562
Name:ANDRADE, VANESSA (DC)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:ANDRADE
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 N TUSTIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-7780
Mailing Address - Country:US
Mailing Address - Phone:714-576-2500
Mailing Address - Fax:
Practice Address - Street 1:172 N TUSTIN ST STE 101
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-7780
Practice Address - Country:US
Practice Address - Phone:714-576-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-26
Last Update Date:2025-03-12
Deactivation Date:2025-02-12
Deactivation Code:
Reactivation Date:2025-03-05
Provider Licenses
StateLicense IDTaxonomies
CADC37196111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor