Provider Demographics
NPI:1811226491
Name:FAUCETT, ANDREA LYNN (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:LYNN
Last Name:FAUCETT
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:VEEDERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47987-1156
Mailing Address - Country:US
Mailing Address - Phone:765-294-2237
Mailing Address - Fax:765-294-2238
Practice Address - Street 1:310 W 5TH ST
Practice Address - Street 2:
Practice Address - City:VEEDERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47987-1156
Practice Address - Country:US
Practice Address - Phone:765-294-2237
Practice Address - Fax:765-294-2238
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-10
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002473A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN265620BMedicare PIN