Provider Demographics
NPI:1083370084
Name:HUCKE, ANDREA JO (DC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:JO
Last Name:HUCKE
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 1:4401 SE FEDERAL HWY UNIT 104
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-5760
Mailing Address - Country:US
Mailing Address - Phone:641-640-0719
Mailing Address - Fax:
Practice Address - Street 1:4401 SE FEDERAL HWY UNIT 104
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-5760
Practice Address - Country:US
Practice Address - Phone:772-286-1720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-14
Last Update Date:2021-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13762111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor