Provider Demographics
NPI:1811099286
Name:THAW, ANDREW HOWARD (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:HOWARD
Last Name:THAW
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 1:10800 N MILITARY TRL
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6527
Mailing Address - Country:US
Mailing Address - Phone:561-775-9111
Mailing Address - Fax:561-775-9131
Practice Address - Street 1:10800 N MILITARY TRL
Practice Address - Street 2:SUITE 111
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6527
Practice Address - Country:US
Practice Address - Phone:561-775-9111
Practice Address - Fax:561-775-9131
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005932111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22346ZOtherMEDICARE PTAN
FL22346OtherBCBS
FL051122600Medicaid
FL051122600Medicaid