Provider Demographics
NPI:1598715872
Name:MEDINA, ANDREA FRANCES (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:FRANCES
Last Name:MEDINA
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 1:3258 N RACINE AVE
Mailing Address - Street 2:#2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3322
Mailing Address - Country:US
Mailing Address - Phone:773-404-8084
Mailing Address - Fax:
Practice Address - Street 1:3258 N RACINE AVE
Practice Address - Street 2:#2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3322
Practice Address - Country:US
Practice Address - Phone:773-404-8084
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILV04371Medicare UPIN