Provider Demographics
NPI:1477851269
Name:MAYBERRY, ANDREW NELSON (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:NELSON
Last Name:MAYBERRY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4824 GRANDVIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-2301
Mailing Address - Country:US
Mailing Address - Phone:863-236-9465
Mailing Address - Fax:
Practice Address - Street 1:4824 GRANDVIEW PKWY
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-2301
Practice Address - Country:US
Practice Address - Phone:863-236-9465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13975111N00000X
GACHIR008748111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor