Provider Demographics
NPI:1235296385
Name:ANDRICK, REBECCA M (DO)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:M
Last Name:ANDRICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:925 S NIAGARA ST
Mailing Address - Street 2:SUITE 370
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-1683
Mailing Address - Country:US
Mailing Address - Phone:303-321-2383
Mailing Address - Fax:303-223-3288
Practice Address - Street 1:925 S NIAGARA ST
Practice Address - Street 2:SUITE 370
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-1683
Practice Address - Country:US
Practice Address - Phone:303-321-2383
Practice Address - Fax:303-223-3288
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2011-05-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO32667207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01326677Medicaid
1568762698OtherNPI TYPE 2 WEIGH TO WELLNESS DENVER
F99765Medicare UPIN