Provider Demographics
NPI:1093854374
Name:FANDRICH, DAVID LELAND (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LELAND
Last Name:FANDRICH
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 1:11225 COMMERCE DR N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-3122
Mailing Address - Country:US
Mailing Address - Phone:763-421-8588
Mailing Address - Fax:
Practice Address - Street 1:11452 JEFFERSON CT
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-2737
Practice Address - Country:US
Practice Address - Phone:763-427-5545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4911111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor