Provider Demographics
NPI:1710048681
Name:KIDDER, ANDREW CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:CHARLES
Last Name:KIDDER
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 1:3211 N MILWAUKEE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-4446
Mailing Address - Country:US
Mailing Address - Phone:208-375-2225
Mailing Address - Fax:208-375-2276
Practice Address - Street 1:3211 N MILWAUKEE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4446
Practice Address - Country:US
Practice Address - Phone:208-375-2225
Practice Address - Fax:208-375-2276
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor