Healthcare Provider Details

I. General information

NPI: 1508915042
Provider Name (Legal Business Name): ANDREW DEAN ENOS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10011-B ORR & DAY RD.
SANTA FE SPRINGS CA
90670-3506
US

IV. Provider business mailing address

PO BOX 3261
SANTA FE SPRINGS CA
90670-0261
US

V. Phone/Fax

Practice location:
  • Phone: 562-929-6033
  • Fax:
Mailing address:
  • Phone: 562-929-6033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC16175
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: