Provider Demographics
NPI:1518343896
Name:KEINROTH, ANDREW JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JOHN
Last Name:KEINROTH
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 1:1092 WALNUT AVE UNIT 102A
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:IA
Mailing Address - Zip Code:52327-9618
Mailing Address - Country:US
Mailing Address - Phone:563-920-7975
Mailing Address - Fax:
Practice Address - Street 1:210 1ST AVE
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2402
Practice Address - Country:US
Practice Address - Phone:563-920-7975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA078969111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor