Healthcare Provider Details

I. General information

NPI: 1891249231
Provider Name (Legal Business Name): ANDREA ANSENBERGER D.C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2016
Last Update Date: 08/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1718 MASSACHUSETTS AVE
CAMBRIDGE MA
02138-1804
US

IV. Provider business mailing address

1718 MASSACHUSETTS AVE
CAMBRIDGE MA
02138-1804
US

V. Phone/Fax

Practice location:
  • Phone: 617-492-5438
  • Fax:
Mailing address:
  • Phone: 617-492-5438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3543
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: