Healthcare Provider Details

I. General information

NPI: 1588746705
Provider Name (Legal Business Name): ANDREW DEAN BEDELL DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MAIN ST
WINDSOR MO
65360-1355
US

IV. Provider business mailing address

100 N MAIN ST
WINDSOR MO
65360-1355
US

V. Phone/Fax

Practice location:
  • Phone: 660-647-5900
  • Fax: 660-647-5900
Mailing address:
  • Phone: 660-647-5900
  • Fax: 660-647-5900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number005662
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: