Provider Demographics
NPI:1942258785
Name:SHAVITZ, ANDREA LEIGH (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:LEIGH
Last Name:SHAVITZ
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 1:3259 N ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-2129
Mailing Address - Country:US
Mailing Address - Phone:773-348-6908
Mailing Address - Fax:773-348-6910
Practice Address - Street 1:3259 N ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-2129
Practice Address - Country:US
Practice Address - Phone:773-348-6908
Practice Address - Fax:773-348-6910
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010650111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor