Provider Demographics
NPI:1588834709
Name:ANDREW C EISELE DC PA
Entity Type:Organization
Organization Name:ANDREW C EISELE DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:C
Authorized Official - Last Name:EISELE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-428-5252
Mailing Address - Street 1:1365 S MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-7634
Mailing Address - Country:US
Mailing Address - Phone:954-428-5252
Mailing Address - Fax:
Practice Address - Street 1:1365 S MILITARY TRL
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-7634
Practice Address - Country:US
Practice Address - Phone:954-428-5252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4582261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service