Provider Demographics
NPI:1821308362
Name:FORMANCZYK, ANDREW MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:MICHAEL
Last Name:FORMANCZYK
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 1:2518 DRIFTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-4805
Mailing Address - Country:US
Mailing Address - Phone:248-760-5325
Mailing Address - Fax:
Practice Address - Street 1:900 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1432
Practice Address - Country:US
Practice Address - Phone:248-656-1011
Practice Address - Fax:248-656-1966
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009705111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor