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General NPI Number Information
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NPI Number | 1104327766
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Entity Type | Individual
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Provider Name | MAKKEL MARIE ANDREAN DA.C, ATC
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Gender | Female
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Dates
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Enumeration Date | 02/27/2018
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 2915 E BASELINE RD STE 126
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City | GILBERT
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State | AZ
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Zip | 85234-2475
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Country | US
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Telephone | 480-620-8798
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Fax |
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Provider Business Mailing Address
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Address Line | 1260 E 1ST PL
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City | MESA
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State | AZ
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Zip | 85203-8920
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Country | US
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Telephone | 480-620-8798
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 011995
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License Number State | AZ
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