Provider Demographics
NPI:1497941694
Name:IVERSON, ANDREW (ND)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:IVERSON
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5609 S LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-5319
Mailing Address - Country:US
Mailing Address - Phone:253-752-7377
Mailing Address - Fax:253-752-8001
Practice Address - Street 1:5609 S LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-5319
Practice Address - Country:US
Practice Address - Phone:253-752-7377
Practice Address - Fax:253-752-8001
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT 00001266175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath