Provider Demographics
NPI:1396845905
Name:VANROO, ANDREW B (DC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:B
Last Name:VANROO
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 1:910 COUNTRYSIDE PKWY
Mailing Address - Street 2:
Mailing Address - City:MONDOVI
Mailing Address - State:WI
Mailing Address - Zip Code:54755-6000
Mailing Address - Country:US
Mailing Address - Phone:715-926-6001
Mailing Address - Fax:
Practice Address - Street 1:910 COUNTRYSIDE PKWY
Practice Address - Street 2:
Practice Address - City:MONDOVI
Practice Address - State:WI
Practice Address - Zip Code:54755-6000
Practice Address - Country:US
Practice Address - Phone:715-926-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3432-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38901000Medicaid
WI38901000Medicaid
WI000335275Medicare ID - Type Unspecified