Provider Demographics
NPI:1972645950
Name:ANDRUS, JOHN P (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:ANDRUS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:P
Other - Last Name:ANDRUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:8950 VILLA LA JOLLA DR
Mailing Address - Street 2:C115
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1714
Mailing Address - Country:US
Mailing Address - Phone:858-453-6020
Mailing Address - Fax:858-450-1922
Practice Address - Street 1:8950 VILLA LA JOLLA DR
Practice Address - Street 2:C115
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1714
Practice Address - Country:US
Practice Address - Phone:858-453-6020
Practice Address - Fax:858-450-1922
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26838111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology