Provider Demographics
NPI:1093823270
Name:SOLOMON, ANDREW IRA (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:IRA
Last Name:SOLOMON
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 1:4401 TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-4679
Mailing Address - Country:US
Mailing Address - Phone:262-552-7999
Mailing Address - Fax:262-552-7998
Practice Address - Street 1:4401 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-4679
Practice Address - Country:US
Practice Address - Phone:262-552-7999
Practice Address - Fax:262-552-7998
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1406012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38752300Medicaid
T63374Medicare UPIN