Provider Demographics
NPI:1164460838
Name:ANDOSCA, HENRE JAMES (DC)
Entity Type:Individual
Prefix:
First Name:HENRE
Middle Name:JAMES
Last Name:ANDOSCA
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 1:1836 NE 7TH AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3978
Mailing Address - Country:US
Mailing Address - Phone:503-506-5120
Mailing Address - Fax:503-506-5121
Practice Address - Street 1:1836 NE 7TH AVE STE 109
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3978
Practice Address - Country:US
Practice Address - Phone:503-506-5120
Practice Address - Fax:503-506-5121
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3326111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAU90130Medicare UPIN
MAY45531Medicare PIN
MAY45531Medicare PIN