Provider Demographics
NPI:1477105971
Name:ORMONDE, ANDREA KATHLEEN (DC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:KATHLEEN
Last Name:ORMONDE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19241 S FRUIT AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93656-9473
Mailing Address - Country:US
Mailing Address - Phone:559-349-4404
Mailing Address - Fax:
Practice Address - Street 1:181 TANK FARM RD STE 120
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7082
Practice Address - Country:US
Practice Address - Phone:805-316-1704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33806111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor