Provider Demographics
NPI:1770663544
Name:CHOI, ANDREW SIMON (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:SIMON
Last Name:CHOI
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 1:973 RUSSELL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3292
Mailing Address - Country:US
Mailing Address - Phone:301-740-8500
Mailing Address - Fax:301-740-8505
Practice Address - Street 1:973 RUSSELL AVE STE A
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3292
Practice Address - Country:US
Practice Address - Phone:301-740-8500
Practice Address - Fax:301-740-8505
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009719111N00000X
MD03473111NR0400X
VA0104556400111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC1267Medicare ID - Type Unspecified