Provider Demographics
NPI:1003140567
Name:MURSU, ANDREA KAY (DC)
Entity Type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:KAY
Last Name:MURSU
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2634 PATRIOT BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-8024
Mailing Address - Country:US
Mailing Address - Phone:847-730-5618
Mailing Address - Fax:847-730-5673
Practice Address - Street 1:2634 PATRIOT BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-8024
Practice Address - Country:US
Practice Address - Phone:847-730-5618
Practice Address - Fax:847-730-5673
Is Sole Proprietor?:No
Enumeration Date:2009-09-30
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor