Provider Demographics
NPI:1467468546
Name:ANDREJCIK, JOSEPH R (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:R
Last Name:ANDREJCIK
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 1:908 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641-1106
Mailing Address - Country:US
Mailing Address - Phone:330-875-3400
Mailing Address - Fax:330-875-9027
Practice Address - Street 1:908 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:OH
Practice Address - Zip Code:44641-1106
Practice Address - Country:US
Practice Address - Phone:330-875-3400
Practice Address - Fax:330-875-9027
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH286111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0268044Medicaid
OH34-6724862OtherTAX ID.
OH346724862 001OtherBC/BS
OH000000143028OtherANTHEM BC/BS
OH311816980OtherMEDICAL MUTUAL
OH34672486200OtherWORKERS COMP
OH791350074OtherRAILROAD MEDICARE
OH34-6724862OtherTAX ID.
OHAN0400182Medicare ID - Type Unspecified