Provider Demographics
NPI:1003217449
Name:REHEISSE, ANDREW J (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:J
Last Name:REHEISSE
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 1:7351 S UNION PARK AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-1869
Mailing Address - Country:US
Mailing Address - Phone:801-944-1855
Mailing Address - Fax:385-351-5950
Practice Address - Street 1:7351 S UNION PARK AVE STE 150
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-1869
Practice Address - Country:US
Practice Address - Phone:801-944-1855
Practice Address - Fax:385-351-5950
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9123542-1202111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor