Healthcare Provider Details

I. General information

NPI: 1083370084
Provider Name (Legal Business Name): ANDREA JO HUCKE DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2021
Last Update Date: 11/14/2021
Certification Date: 11/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 SE FEDERAL HWY UNIT 104
STUART FL
34997-5760
US

IV. Provider business mailing address

4401 SE FEDERAL HWY UNIT 104
STUART FL
34997-5760
US

V. Phone/Fax

Practice location:
  • Phone: 772-286-1720
  • Fax:
Mailing address:
  • Phone: 641-640-0719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number13762
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: