Provider Demographics
NPI:1497914352
Name:WAWRA, ANDREW JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JAMES
Last Name:WAWRA
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 1:3 HEALTH DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-0240
Mailing Address - Country:US
Mailing Address - Phone:207-623-0720
Mailing Address - Fax:207-623-0724
Practice Address - Street 1:3 HEALTH DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-0240
Practice Address - Country:US
Practice Address - Phone:207-623-0720
Practice Address - Fax:207-623-0724
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5129111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor