Provider Demographics
NPI:1164742201
Name:ANDRADE, MICHELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:ANDRADE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:5608 PARKCREST DR STE 350
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4976
Mailing Address - Country:US
Mailing Address - Phone:512-371-1886
Mailing Address - Fax:512-371-1665
Practice Address - Street 1:5608 PARKCREST DR STE 350
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4976
Practice Address - Country:US
Practice Address - Phone:512-371-1886
Practice Address - Fax:512-371-1665
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11195111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor