Provider Demographics
NPI:1891163515
Name:FUNK, ANDREW JOSEPH (DC, DACNB)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JOSEPH
Last Name:FUNK
Suffix:
Gender:
Credentials:DC, DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5757 S MACADAM AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3789
Mailing Address - Country:US
Mailing Address - Phone:503-445-7999
Mailing Address - Fax:503-445-7997
Practice Address - Street 1:5757 S MACADAM AVE STE 150
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3789
Practice Address - Country:US
Practice Address - Phone:503-445-7999
Practice Address - Fax:503-445-7997
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2025-05-11
Deactivation Date:2022-10-05
Deactivation Code:
Reactivation Date:2022-10-19
Provider Licenses
StateLicense IDTaxonomies
OR5658111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology