Provider Demographics
NPI:1386304905
Name:HALL, ANDREW W
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:W
Last Name:HALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 BEE RIDGE RD.
Mailing Address - Street 2:BUILDING D SUITE 101
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1261
Mailing Address - Country:US
Mailing Address - Phone:855-745-1821
Mailing Address - Fax:
Practice Address - Street 1:3920 BEE RIDGE RD.
Practice Address - Street 2:BUILDING D SUITE 101
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1261
Practice Address - Country:US
Practice Address - Phone:855-745-1821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13695111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor