Provider Demographics
NPI:1972685634
Name:DAVIDSON, ANDREA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MARIE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:MARIE
Other - Last Name:WOCHENSKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1431 W MASON ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-2120
Mailing Address - Country:US
Mailing Address - Phone:920-405-0050
Mailing Address - Fax:920-405-0553
Practice Address - Street 1:1431 W MASON ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-2120
Practice Address - Country:US
Practice Address - Phone:920-405-0050
Practice Address - Fax:920-405-0553
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4086-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38963900Medicaid
U96496Medicare UPIN
WI000007012Medicare UPIN
000035813Medicare PIN