Provider Demographics
NPI:1861498040
Name:ANDREW, SAMUEL KEITH (DCMAC)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:KEITH
Last Name:ANDREW
Suffix:
Gender:M
Credentials:DCMAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-3905
Mailing Address - Country:US
Mailing Address - Phone:704-983-3552
Mailing Address - Fax:704-983-4660
Practice Address - Street 1:330 N 1ST ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3905
Practice Address - Country:US
Practice Address - Phone:704-983-3552
Practice Address - Fax:704-983-4660
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1787111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908215Medicaid
NCU02628Medicare UPIN
NC8908215Medicaid