Provider Demographics
NPI:1114355088
Name:DEFOREST, ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:DEFOREST
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:ANDREW
Other - Middle Name:
Other - Last Name:DEFOREST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DAC
Mailing Address - Street 1:641 LUAHOANA PL
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-5411
Mailing Address - Country:US
Mailing Address - Phone:808-283-2217
Mailing Address - Fax:808-283-2217
Practice Address - Street 1:641 LUAHOANA PL
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-5411
Practice Address - Country:US
Practice Address - Phone:808-283-2217
Practice Address - Fax:808-283-2217
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-31
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI641111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition