Healthcare Provider Details

I. General information

NPI: 1801401872
Provider Name (Legal Business Name): ANDREW MAHLMEISTER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17682 BEACH BLVD STE 203
HUNTINGTON BEACH CA
92647-6812
US

IV. Provider business mailing address

2737 CAMPUS DR
IRVINE CA
92612-1602
US

V. Phone/Fax

Practice location:
  • Phone: 714-745-7643
  • Fax:
Mailing address:
  • Phone: 949-476-1250
  • Fax: 949-474-7331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number34821
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: