Provider Demographics
NPI:1568526945
Name:VINSON, ANDREA COATES (DC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:COATES
Last Name:VINSON
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:PO BOX 1108
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01931-1108
Mailing Address - Country:US
Mailing Address - Phone:978-281-4977
Mailing Address - Fax:978-281-4976
Practice Address - Street 1:25 DUNCAN ST
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-6001
Practice Address - Country:US
Practice Address - Phone:978-281-4977
Practice Address - Fax:978-281-4976
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA942111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA351046OtherHARVARD PILGRIM HEALTH PL
MAY35701OtherBLUE CROSS BLUE SHIELD
MA716051OtherTUFTS HEALTH PLAN
MA121738OtherPHCS
MAY35701OtherBLUE CROSS BLUE SHIELD