Provider Demographics
NPI:1902835127
Name:IGNACIO, ANDREA MAUREEN (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MAUREEN
Last Name:IGNACIO
Suffix:
Gender:F
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:PO BOX 3625
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-6625
Mailing Address - Country:US
Mailing Address - Phone:505-425-5402
Mailing Address - Fax:505-425-8643
Practice Address - Street 1:98 STATE HIGHWAY 150
Practice Address - Street 2:#7
Practice Address - City:EL PRADO
Practice Address - State:NY
Practice Address - Zip Code:87529
Practice Address - Country:US
Practice Address - Phone:575-776-1117
Practice Address - Fax:575-776-1118
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1575111N00000X
NMDC2285111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor