Provider Demographics
NPI:1285630491
Name:ANDRESS, DAVID LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
Last Name:ANDRESS
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:PO BOX 385
Mailing Address - Street 2:
Mailing Address - City:MENAHGA
Mailing Address - State:MN
Mailing Address - Zip Code:56464-0385
Mailing Address - Country:US
Mailing Address - Phone:218-564-4200
Mailing Address - Fax:
Practice Address - Street 1:19 3RD STREET SE
Practice Address - Street 2:
Practice Address - City:MENAHGA
Practice Address - State:MN
Practice Address - Zip Code:56464-0385
Practice Address - Country:US
Practice Address - Phone:218-564-4200
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2980111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U28566Medicare UPIN