Provider Demographics
NPI:1992953327
Name:ANDREWS CHIROPRACTIC & ACUPUNCTURE CENTER OF SEMO,LLC
Entity type:Organization
Organization Name:ANDREWS CHIROPRACTIC & ACUPUNCTURE CENTER OF SEMO,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:KHONDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-243-8983
Mailing Address - Street 1:3874 E JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-3710
Mailing Address - Country:US
Mailing Address - Phone:573-243-8983
Mailing Address - Fax:573-243-7209
Practice Address - Street 1:3874 E JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-3710
Practice Address - Country:US
Practice Address - Phone:573-243-8983
Practice Address - Fax:573-243-7209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004660261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2930OtherBLUE CROSS BLUE SHIELD
MO000031083Medicare PIN
MOT43509Medicare UPIN