Provider Demographics
NPI:1326063983
Name:BEDELL, ANDREW ALEX (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:ALEX
Last Name:BEDELL
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 1:638 E YOUNG AVE
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-9608
Mailing Address - Country:US
Mailing Address - Phone:660-429-5533
Mailing Address - Fax:660-429-5554
Practice Address - Street 1:638 E YOUNG AVE
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-9608
Practice Address - Country:US
Practice Address - Phone:660-429-5533
Practice Address - Fax:660-429-5554
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002024548111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000C984Medicare ID - Type Unspecified
MOU39153Medicare UPIN