Healthcare Provider Details

I. General information

NPI: 1891116927
Provider Name (Legal Business Name): ANDREA KNEESSI DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2013
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 WEST ST UNIT 205
ANNAPOLIS MD
21401-3764
US

IV. Provider business mailing address

9300 LIVINGSTON RD SUITE 100
FORT WASHINGTON MD
20744-4908
US

V. Phone/Fax

Practice location:
  • Phone: 443-808-8948
  • Fax: 443-837-6354
Mailing address:
  • Phone: 240-766-0300
  • Fax: 240-766-0304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberS03766
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: