Provider Demographics
NPI:1609950427
Name:LIND, ANDREW STEVEN (DC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:STEVEN
Last Name:LIND
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 1:36945 COOK ST STE 103
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6077
Mailing Address - Country:US
Mailing Address - Phone:760-565-1158
Mailing Address - Fax:760-565-1168
Practice Address - Street 1:36945 COOK ST STE 103
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6077
Practice Address - Country:US
Practice Address - Phone:760-565-1158
Practice Address - Fax:760-565-1168
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18510111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05310ZOtherBLUE SHIELD NUMBER
CA330937637OtherTAX IDENTIFICATION NUMBER