MEDICARE: ANDC, INC

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	111NN0400X	Neurology Chiropractor	B5518	AZ

General Provider Information

NPI Number	:	1437282100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDC, INC

Provider Business Mailing Address
First Line	:	40116 N INTEGRITY TRL
Second Line	:
City	:	ANTHEM
State	:	AZ
Zip	:	85086-6015
Country	:	US
Telephone Number	:	928-522-8459
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 E CEDAR AVE STE 80
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86004-1644
Country	:	US
Telephone Number	:	928-522-8459
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. TIMOTHY FRANK MARTIN
Credential	:	DC
Telephone Number	:	928-522-8459

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	08/22/2020

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