Provider Demographics
NPI:1972723633
Name:TAMI R. ANDREWS
Entity Type:Organization
Organization Name:TAMI R. ANDREWS
Other - Org Name:LAKE ELMO CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-779-7858
Mailing Address - Street 1:3511 LAKE ELMO AVE N
Mailing Address - Street 2:P.O. BOX 160
Mailing Address - City:LAKE ELMO
Mailing Address - State:MN
Mailing Address - Zip Code:55042-8469
Mailing Address - Country:US
Mailing Address - Phone:651-779-7858
Mailing Address - Fax:651-777-2426
Practice Address - Street 1:3511 LAKE ELMO AVE N
Practice Address - Street 2:
Practice Address - City:LAKE ELMO
Practice Address - State:MN
Practice Address - Zip Code:55042-8469
Practice Address - Country:US
Practice Address - Phone:651-779-7858
Practice Address - Fax:651-777-2426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3095111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty