Provider Demographics
NPI:1699705384
Name:ANDREW CHIROPRACTIC & ACUPUNCTURE CLINIC, PA
Entity type:Organization
Organization Name:ANDREW CHIROPRACTIC & ACUPUNCTURE CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:ANDREW
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MAC
Authorized Official - Phone:704-983-3552
Mailing Address - Street 1:330 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-3905
Mailing Address - Country:US
Mailing Address - Phone:704-983-3552
Mailing Address - Fax:704-983-4660
Practice Address - Street 1:330 N 1ST ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3905
Practice Address - Country:US
Practice Address - Phone:704-983-3552
Practice Address - Fax:704-983-4660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1787111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty