Provider Demographics
NPI:1811224082
Name:ANDREWS, MICHAEL BRYAN (DC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:BRYAN
Last Name:ANDREWS
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 1:8325 HAVEN AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3894
Mailing Address - Country:US
Mailing Address - Phone:909-466-4590
Mailing Address - Fax:909-466-4598
Practice Address - Street 1:8325 HAVEN AVE STE 120
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3894
Practice Address - Country:US
Practice Address - Phone:909-466-4590
Practice Address - Fax:909-466-4598
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29682111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician