Provider Demographics
NPI:1033123500
Name:DANDREA, RAYMOND M (DC)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:M
Last Name:DANDREA
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:PO BOX 13276
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98508-3276
Mailing Address - Country:US
Mailing Address - Phone:360-352-9100
Mailing Address - Fax:360-352-9108
Practice Address - Street 1:1655 COOPER POINT RD SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5735
Practice Address - Country:US
Practice Address - Phone:360-352-9100
Practice Address - Fax:360-352-9108
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034604111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor