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General NPI Number Information
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NPI Number | 1669765483
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Entity Type | Individual
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Provider Name | ANDREW C UNFRIED D.C.
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Gender | Male
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Dates
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Enumeration Date | 05/26/2011
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Last Update Date | 07/15/2019
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Provider Practice Location Address
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Address Line | 5 GLEN ED PROFESSIONAL PARK
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City | GLEN CARBON
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State | IL
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Zip | 62034-3333
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Country | US
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Telephone | 618-558-2429
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Fax |
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Provider Business Mailing Address
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Address Line | 917 COPPER RIDGE DR
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City | MARYVILLE
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State | IL
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Zip | 62062-5679
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Country | US
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Telephone | 618-558-2429
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038.011939
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License Number State | IL
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