Provider Demographics
NPI:1902179104
Name:ANDA, GEOFFREY LEIGH (DC)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:LEIGH
Last Name:ANDA
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 1:1011 43 1/2 ST SW
Mailing Address - Street 2:APARTMENT 104
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-7324
Mailing Address - Country:US
Mailing Address - Phone:763-639-5838
Mailing Address - Fax:
Practice Address - Street 1:3369 39TH ST S
Practice Address - Street 2:SUITE 3
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7542
Practice Address - Country:US
Practice Address - Phone:701-367-6980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND902111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor