Healthcare Provider Details

I. General information

NPI: 1104327766
Provider Name (Legal Business Name): MAKKEL MARIE ANDREAN DA.C, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 E BASELINE RD STE 126
GILBERT AZ
85234-2475
US

IV. Provider business mailing address

1260 E 1ST PL
MESA AZ
85203-8920
US

V. Phone/Fax

Practice location:
  • Phone: 480-620-8798
  • Fax:
Mailing address:
  • Phone: 480-620-8798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number011995
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: