Provider Demographics
NPI:1992924526
Name:ANDREWS CHIROPRACTIC, P.A.
Entity type:Organization
Organization Name:ANDREWS CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-427-0820
Mailing Address - Street 1:3368 BUNKER LAKE BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-3787
Mailing Address - Country:US
Mailing Address - Phone:763-427-0820
Mailing Address - Fax:763-421-1044
Practice Address - Street 1:3368 BUNKER LAKE BLVD NW
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-3787
Practice Address - Country:US
Practice Address - Phone:763-427-0820
Practice Address - Fax:763-421-1044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2531111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNT39989Medicare UPIN
MN350002056Medicare ID - Type Unspecified