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General NPI Number Information
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NPI Number | 1063546851
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Entity Type | Organization
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Legal Business Name | ANDREW I SOLOMON DC SC
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4401 TAYLOR AVENUE
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City | RACINE
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State | WI
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Zip | 53405-4679
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Country | US
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Telephone | 262-552-7999
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Fax | 262-552-7998
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Provider Business Mailing Address
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Address Line | 4401 TAYLOR AVENUE
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City | RACINE
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State | WI
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Zip | 53405-4679
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Country | US
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Telephone | 262-552-7999
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Fax | 262-552-7998
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANDREW IRA SOLOMON
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Credential | DC
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Telephone | 262-552-7999
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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 | 1406012
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License Number State | WI
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