Provider Demographics
NPI:1336140540
Name:BOETTCHER, ANDREAS (DC)
Entity Type:Individual
Prefix:MR
First Name:ANDREAS
Middle Name:
Last Name:BOETTCHER
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 1:42104 N VENTURE DR
Mailing Address - Street 2:BLDG E
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-3823
Mailing Address - Country:US
Mailing Address - Phone:623-551-9100
Mailing Address - Fax:623-551-9103
Practice Address - Street 1:42104 N VENTURE DR
Practice Address - Street 2:BLDG E
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-3823
Practice Address - Country:US
Practice Address - Phone:623-551-9100
Practice Address - Fax:623-551-9103
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6072111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U85217Medicare UPIN
AZ64242Medicare ID - Type Unspecified