Provider Demographics
NPI:1376074963
Name:CAROON, ANDREW (DC, MS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:CAROON
Suffix:
Gender:M
Credentials:DC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 NW 23RD AVE
Mailing Address - Street 2:#201
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3237
Mailing Address - Country:US
Mailing Address - Phone:425-890-9804
Mailing Address - Fax:
Practice Address - Street 1:621 NW 23RD AVE
Practice Address - Street 2:#201
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3237
Practice Address - Country:US
Practice Address - Phone:425-890-9804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5809111N00000X
WACH 60723055111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor