Provider Demographics
NPI:1477697969
Name:MEVOLI, ANDREANA (DC)
Entity Type:Individual
Prefix:
First Name:ANDREANA
Middle Name:
Last Name:MEVOLI
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 1:2000 HEARST AVE # 201
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-2130
Mailing Address - Country:US
Mailing Address - Phone:510-704-1505
Mailing Address - Fax:510-704-1508
Practice Address - Street 1:2000 HEARST AVE # 201
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-2130
Practice Address - Country:US
Practice Address - Phone:510-704-1505
Practice Address - Fax:510-704-1508
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-30497111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor