Provider Demographics
NPI:1730314899
Name:CHICHICK, ANDREW IV (IDMT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:CHICHICK
Suffix:IV
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 ARNOLD DRIVE
Mailing Address - Street 2:19 AMDS/SGPF
Mailing Address - City:LITTLE ROCK AFB
Mailing Address - State:AR
Mailing Address - Zip Code:72099
Mailing Address - Country:US
Mailing Address - Phone:501-987-7319
Mailing Address - Fax:501-987-7349
Practice Address - Street 1:1090 ARNOLD DRIVE
Practice Address - Street 2:19 AMDS/SGPF
Practice Address - City:LITTLE ROCK AFB
Practice Address - State:AR
Practice Address - Zip Code:72099
Practice Address - Country:US
Practice Address - Phone:501-987-7319
Practice Address - Fax:501-987-7349
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians