Provider Demographics
NPI:1093853558
Name:MCCAULLEY, ANDREW NATHAN (DC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:NATHAN
Last Name:MCCAULLEY
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 1:1919 W 57TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2711
Mailing Address - Country:US
Mailing Address - Phone:605-362-1225
Mailing Address - Fax:605-362-9525
Practice Address - Street 1:1919 W 57TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2711
Practice Address - Country:US
Practice Address - Phone:605-362-1225
Practice Address - Fax:605-362-9525
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD927111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6901Medicare ID - Type Unspecified