Provider Demographics
NPI:1942419908
Name:ILOWITZ, ANDREW SAMUEL (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:SAMUEL
Last Name:ILOWITZ
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:PO BOX 662
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06881-0662
Mailing Address - Country:US
Mailing Address - Phone:203-226-3235
Mailing Address - Fax:
Practice Address - Street 1:129 KINGS HWY N
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-2438
Practice Address - Country:US
Practice Address - Phone:203-226-3235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000919111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT203258469OtherTAX IDENTIFICATION NUMBER