Provider Demographics
NPI:1619970209
Name:WEST, ANDREW EDMUND (DC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:EDMUND
Last Name:WEST
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:PO BOX 3176
Mailing Address - Street 2:
Mailing Address - City:CHAMPLAIN
Mailing Address - State:NY
Mailing Address - Zip Code:12919-3176
Mailing Address - Country:US
Mailing Address - Phone:518-297-2723
Mailing Address - Fax:518-297-3364
Practice Address - Street 1:333 STATE ROUTE 11
Practice Address - Street 2:
Practice Address - City:CHAMPLAIN
Practice Address - State:NY
Practice Address - Zip Code:12919-4817
Practice Address - Country:US
Practice Address - Phone:518-297-2723
Practice Address - Fax:518-297-3364
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007066111N00000X
VT006.0070788111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY53846BMedicare ID - Type Unspecified
NYU37398Medicare UPIN