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General NPI Number Information
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NPI Number | 1043508609
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Entity Type | Organization
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Legal Business Name | MICHAEL ANDREWS
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Dates
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Enumeration Date | 07/18/2011
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Last Update Date | 07/18/2011
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Provider Practice Location Address
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Address Line | 8325 HAVEN AVE SUITE 120
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3894
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Country | US
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Telephone | 909-466-4590
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Fax | 909-466-4598
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Provider Business Mailing Address
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Address Line | 8325 HAVEN AVE SUITE 120
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3894
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Country | US
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Telephone | 909-466-4590
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Fax | 909-466-4598
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHAEL BRYAN ANDREWS
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Credential | DC
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Telephone | 909-466-4590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 29682
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License Number State | CA
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