Provider Demographics
NPI:1679593529
Name:ANDRASHKO, MARY (DC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:ANDRASHKO
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 1:8421 WAYZATA BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1380
Mailing Address - Country:US
Mailing Address - Phone:952-253-3880
Mailing Address - Fax:952-253-3882
Practice Address - Street 1:8421 WAYZATA BLVD
Practice Address - Street 2:STE 220
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55426-1380
Practice Address - Country:US
Practice Address - Phone:952-253-3880
Practice Address - Fax:952-253-3882
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3457111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5C732ANOtherBLUE CROSS BLUE SHIELD
MN1962690784Medicaid
MN5C732ANOtherBLUE CROSS BLUE SHIELD