Provider Demographics
NPI:1568979318
Name:ANDRAOS, THERESA A
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:A
Last Name:ANDRAOS
Suffix:
Gender:F
Credentials:
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 196
Mailing Address - Street 2:
Mailing Address - City:CHEYNEY
Mailing Address - State:PA
Mailing Address - Zip Code:19319-0196
Mailing Address - Country:US
Mailing Address - Phone:610-291-0211
Mailing Address - Fax:
Practice Address - Street 1:419 N FRANKLIN ST STE 1
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-2400
Practice Address - Country:US
Practice Address - Phone:610-431-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011296111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty