Provider Demographics
NPI:1356531578
Name:MILLAR, ANDREW JUDSON (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JUDSON
Last Name:MILLAR
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 644
Mailing Address - Street 2:
Mailing Address - City:POUGHQUAG
Mailing Address - State:NY
Mailing Address - Zip Code:12570-5106
Mailing Address - Country:US
Mailing Address - Phone:845-724-4840
Mailing Address - Fax:845-724-4841
Practice Address - Street 1:2567 ROUTE 55
Practice Address - Street 2:
Practice Address - City:POUGHQUAG
Practice Address - State:NY
Practice Address - Zip Code:12570-5106
Practice Address - Country:US
Practice Address - Phone:845-724-4840
Practice Address - Fax:845-724-4841
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00782111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO7820-6OtherWORKER'S COMPENSATION
NYCO7820-6OtherWORKER'S COMPENSATION
NYX6572-1(2)Medicare PIN