Provider Demographics
NPI:1528109097
Name:EISELE, ANDREW C (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:C
Last Name:EISELE
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 1:1365 S MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-7634
Mailing Address - Country:US
Mailing Address - Phone:954-428-5252
Mailing Address - Fax:
Practice Address - Street 1:1365 S MILITARY TRL
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-7634
Practice Address - Country:US
Practice Address - Phone:954-428-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004582111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050643500Medicaid
FL70673ZOtherMEDICARE PTAN
FL70673ZOtherMEDICARE PTAN