MEDICARE: ANDREW OH DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	36601	CA

General Provider Information

NPI Number	:	1033960497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW OH DC

Provider Business Mailing Address
First Line	:	5880 FAIR ISLE DR APT 22
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-8452
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	22635 ALESSANDRO BLVD STE 400
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92553-8550
Country	:	US
Telephone Number	:	951-697-0246
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2024
Last Update Date	:	04/01/2024

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Directions to “ ANDREW OH DC” Practice Location

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