Provider Demographics
NPI:1972689347
Name:BOURDEINYI, ANDREI PETROVICH (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREI
Middle Name:PETROVICH
Last Name:BOURDEINYI
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 1:1625 ROSWELL RD
Mailing Address - Street 2:APT.138
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-3682
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3155 ROSWELL RD NE
Practice Address - Street 2:SUITE 140
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1821
Practice Address - Country:US
Practice Address - Phone:404-231-1000
Practice Address - Fax:404-231-5546
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006547111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
11303651OtherCAQH
GA7467540OtherAETNA INSURANCE COMPANY
649113OtherUNITED HEALTH CARE INS.CO
GA35ZCHZFMedicare ID - Type Unspecified