Provider Demographics
NPI:1255426995
Name:SMITH, ANDREW MICHAEL (DC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:MICHAEL
Last Name:SMITH
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 1:2200 ROUTE 10
Mailing Address - Street 2:SUITE 109
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-5304
Mailing Address - Country:US
Mailing Address - Phone:973-538-5433
Mailing Address - Fax:973-538-3388
Practice Address - Street 1:2200 ROUTE 10
Practice Address - Street 2:SUITE 109
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-5304
Practice Address - Country:US
Practice Address - Phone:973-538-5433
Practice Address - Fax:973-538-3388
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004927L111N00000X
NJ38MC00425100111N00000X
NY70006923111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor