Provider Demographics
NPI:1730459512
Name:FETZEK, ANDREA ELIZABETH (DC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:ELIZABETH
Last Name:FETZEK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:ELIZABETH
Other - Last Name:WAHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:15 8TH AVE N
Mailing Address - Street 2:HOPKINS HEALTH & WELLNESS
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343
Mailing Address - Country:US
Mailing Address - Phone:952-933-5085
Mailing Address - Fax:612-315-4473
Practice Address - Street 1:15 8TH AVE N
Practice Address - Street 2:HOPKINS HEALTH & WELLNESS
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343
Practice Address - Country:US
Practice Address - Phone:952-933-5085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5619111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor