Provider Demographics
NPI:1578806626
Name:FIOLA, ANDREW JORDAN (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JORDAN
Last Name:FIOLA
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 1:109 ANDREW AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-3156
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:109 ANDREW AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-3156
Practice Address - Country:US
Practice Address - Phone:617-536-1161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3483111N00000X
TX12274111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor