Provider Demographics
NPI:1558654566
Name:BONDY, ANDREA TOWERS
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:TOWERS
Last Name:BONDY
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:DAWN
Other - Last Name:TOWERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:857 HEALTH PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7383
Mailing Address - Country:US
Mailing Address - Phone:810-344-9279
Mailing Address - Fax:810-344-9470
Practice Address - Street 1:857 HEALTH PARK BLVD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-7383
Practice Address - Country:US
Practice Address - Phone:810-344-9279
Practice Address - Fax:810-344-9470
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009667111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI5906Medicare PIN