Healthcare Provider Details

I. General information

NPI: 1619970209
Provider Name (Legal Business Name): ANDREW EDMUND WEST D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 11/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 STATE ROUTE 11
CHAMPLAIN NY
12919-4817
US

IV. Provider business mailing address

PO BOX 3176
CHAMPLAIN NY
12919-3176
US

V. Phone/Fax

Practice location:
  • Phone: 518-297-2723
  • Fax: 518-297-3364
Mailing address:
  • Phone: 518-297-2723
  • Fax: 518-297-3364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number007066
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number006.0070788
License Number StateVT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: