Provider Demographics
NPI:1003020983
Name:SUTHERLAND, ANDREW D (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:D
Last Name:SUTHERLAND
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5179 S JOHN YOUNG PARKWAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839
Mailing Address - Country:US
Mailing Address - Phone:407-242-5972
Mailing Address - Fax:407-816-9569
Practice Address - Street 1:5179 S JOHN YOUNG PARKWAY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839
Practice Address - Country:US
Practice Address - Phone:407-242-5972
Practice Address - Fax:407-816-9569
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9218111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor