Provider Demographics
NPI:1710024112
Name:NEVILLE, ANDREW PATRICK LAWRENCE (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:PATRICK LAWRENCE
Last Name:NEVILLE
Suffix:
Gender:M
Credentials:DC
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Other - Credentials:
Mailing Address - Street 1:1333 COLLEGE AVE
Mailing Address - Street 2:POTISK CHIROPRACTIC STE M
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-1150
Mailing Address - Country:US
Mailing Address - Phone:414-762-8441
Mailing Address - Fax:414-762-0755
Practice Address - Street 1:829 S GREEN BAY RD
Practice Address - Street 2:STE 101
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-4058
Practice Address - Country:US
Practice Address - Phone:262-633-6325
Practice Address - Fax:262-633-6326
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI4068-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38960600Medicaid
WIV04420Medicare UPIN
WI000775667Medicare ID - Type Unspecified