Healthcare Provider Details

I. General information

NPI: 1043780307
Provider Name (Legal Business Name): ANDREW K WARREN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2018
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 PLANTATION ISLAND DR S STE 9
SAINT AUGUSTINE FL
32080-3106
US

IV. Provider business mailing address

411 JASMINE RD
SAINT AUGUSTINE FL
32086-6437
US

V. Phone/Fax

Practice location:
  • Phone: 904-217-0715
  • Fax: 904-217-0746
Mailing address:
  • Phone: 240-298-3241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number12638
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: