Provider Demographics
NPI:1174642748
Name:MINOR, ANDY LANE (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDY
Middle Name:LANE
Last Name:MINOR
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 1:801 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-3707
Mailing Address - Country:US
Mailing Address - Phone:816-228-5522
Mailing Address - Fax:816-220-0205
Practice Address - Street 1:801 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-3707
Practice Address - Country:US
Practice Address - Phone:816-228-5522
Practice Address - Fax:816-220-0205
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005001169111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO35144011OtherBCBS-KC
MO35144011OtherBCBS-KC