Healthcare Provider Details

I. General information

NPI: 1942507702
Provider Name (Legal Business Name): ANDREA N VERDEYEN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2011
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 CLOCK TOWER DR SUITE B
SPRINGFIELD IL
62704-1388
US

IV. Provider business mailing address

960 CLOCK TOWER DR SUITE B
SPRINGFIELD IL
62704-1388
US

V. Phone/Fax

Practice location:
  • Phone: 618-210-1111
  • Fax:
Mailing address:
  • Phone: 618-210-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038011853
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number038011853
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: